Metabolic status modifies the predictive value of the C-reactive protein-triglyceride-glucose Index-waist-to-height ratio for major adverse cardiovascular and cerebrovascular events: a prospective cohort study from the China Health and Retirement Longitudinal Study (CHARLS).

No subgroup demonstrated a statistically significant association between CTI-WHtR and MACCE in the fully adjusted model, although the elderly subgroup (age ≥ 60 years) approached significance (HR 1.16, 95% CI 1.00–1.34, P = 0.053) and the overweight subgroup (BMI ≥ 24) showed a trend (HR 1.09, 95% CI 0.96–1.25, P = 0.19).

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Notably, the T2D Model 3 Q4 HR of 1.60 (95% CI 0.97–2.62) approached significance, suggesting a possible residual dose–response relationship that was underpowered in this smaller subgroup (n = 966, 252 events).

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Thus, while the directional pattern of group-switching was consistent across all four index pairs, the absolute C-index differences (0.001–0.006) were small and did not reach statistical significance, indicating that the group-switching phenomenon represents a descriptive trend requiring confirmation in larger studies.

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