a strong trendP < 0.001
This association demonstrated greater magnitude for heart disease subtypes, where Q4 exhibited 50.9% increased risk versus Q1 (OR = 1.509, 95% CI: 1.118–2.046) and each 1-SD increment conferred 19.8% higher risk (OR = 1.198, 95% CI: 1.079–1.331), with a strong trend significance ( P < 0.001) (Additional file 1: Table S3).