Composite CCHG Biomarker Associates with Elevated Stroke Risk in Cohort Study

An elevated composite biomarker combining C-reactive protein with the cholesterol–high-density lipoprotein–glucose index, termed the CCHG index, is significantly correlated with an increased risk of stroke, according to findings from a cohort study of 6,804 adults aged 45 years and older. During a median follow-up of nine years from 2011 to 2020 using data from the CHARLS database, 675 participants (9.9%) developed stroke. Investigators evaluated the composite index because systemic inflammation and insulin resistance are closely linked in cerebrovascular disease, yet no existing biomarker had integrated an inflammatory marker with the CHG index for stroke risk prediction.

In unadjusted Cox regression models, the triglyceride–glucose (TyG) index (hazard ratio [HR] = 1.37, 95% CI: 1.24–1.52, p < 0.001), the CHG index (HR = 1.64, 95% CI: 1.41–1.90, p < 0.001), and the CCHG index (HR = 1.52, 95% CI: 1.37–1.68, p < 0.001) were all significantly associated with stroke risk. After full multivariable adjustment in Model 3, these associations persisted, yielding adjusted hazard ratios for incident stroke of 1.30 (95% CI: 1.15–1.47) for CCHG, 1.34 (95% CI: 1.10–1.62) for CHG, and 1.23 (95% CI: 1.09–1.39) for TyG.

Dose–response analyses utilizing restricted cubic splines demonstrated a linear relationship between the TyG index and stroke risk, whereas both the CHG and CCHG indices exhibited positive non-linear associations. Furthermore, receiver operating characteristic curve analysis revealed that the novel CCHG index achieved a modestly higher discriminative ability in predictive performance compared with both the TyG and CHG indices.

Subgroup analyses showed no statistically significant interactions for the CHG or CCHG indices across evaluated demographic and clinical subgroups (p for interaction > 0.05). By contrast, an interaction was observed between the TyG index and hypertension status (p for interaction = 0.046), distinguishing the predictive profile of CCHG across broader patient categories.

Subject of Research: Predictive value of the composite CCHG index for stroke risk

Article Title: Predictive value of cholesterol, high-density lipoprotein and glucose (CHG) index combined with C-reactive protein for stroke risk: a cohort study

Article References: Bai, J., Xu, G., Li, T., & Wang, W. (2026). Predictive value of cholesterol, high-density lipoprotein and glucose (CHG) index combined with C-reactive protein for stroke risk: a cohort study. BMC Neurology. https://doi.org/10.1186/s12883-026-05607-9

Image Credits: AI Generated

DOI: 10.1186/s12883-026-05607-9

Keywords: stroke risk, CCHG index, C-reactive protein, cholesterol, CHG index, TyG index, insulin resistance, CHARLS cohort, Predictive, value, high-density, lipoprotein