A body shape index combined with the triglyceride-glucose index for cardiovascular risk prediction in overweight and obese Chinese adults

Background Overweight and obesity are major modifiable risk factors for cardiovascular disease (CVD). A body shape index (ABSI) reflects abdominal adiposity independently of body mass index (BMI), whereas the triglyceride–glucose (TyG) index is a validated surrogate marker of insulin resistance (IR). Therefore, the present study aimed to evaluate the independent and combined predictive value of ABSI and the TyG index for CVD risk among overweight and obese Chinese adults. Methods This retrospective cohort study included 920 overweight or obese adults aged 40–80 years who were free of CVD at baseline and underwent routine health examinations at the First Affiliated Hospital of Xinjiang Medical University from January 2019 to October 2019. Baseline anthropometric indices, including BMI, waist circumference (WC), waist-to-height ratio (WHtR), body roundness index (BRI), and ABSI, as well as laboratory parameters, were assessed at enrollment. Participants were followed through October 2024. Logistic regression was used to examine associations between indices and incident CVD. Restricted cubic spline (RCS) analysis assessed nonlinear relationships. Predictive performance was evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC). Results Among 920 participants, 310 (33.7%) developed CVD during follow-up. Logistic regression showed that both the TyG index (OR: 2.093; 95% CI: 1.532–2.889) and ABSI (OR: 1.791; 95% CI: 1.432–2.256) were independently associated with incident CVD after multivariable adjustment. RCS analysis demonstrated a nonlinear S-shaped association between the TyG index and CVD ( P for nonlinearity = 0.006), while ABSI exhibited a linear relationship ( P for nonlinearity = 0.390). ROC analysis indicated that the TyG index (AUC = 0.636), ABSI (AUC = 0.634), WC (AUC = 0.611), triglycerides (TG; AUC = 0.616), and BRI had moderate predictive ability. The combined model of TyG + ABSI achieved the highest predictive accuracy (AUC = 0.679, 95% CI: 0.644–0.715). Conclusion Both ABSI and the TyG index were independently associated with incident CVD in overweight and obese Chinese adults. Their combined use demonstrated a modest improvement in discriminative performance compared with either index alone, suggesting potential complementary value for cardiovascular risk assessment.