Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 17, Number 5, October 2026, pages 497-508

Association Between Cholesterol–HDL–Glucose Index and Stroke Risk in Middle-Aged and Elderly Adults Without Diabetes: Evidence From Two National Cohort Studies

↓ Figure 3. Restricted cubic spline models analyze the relationship between the CHG index and stroke incidence. (a) Unadjusted Model. (b) Adjusted for age, gender, marital status, residence, education, smoking status, drinking status, and hypertension. CHG index: cholesterol–HDL–glucose index.

↓ Figure 4. Receiver operating characteristic curve for the CHG index and the TyG index in predicting stroke incidence. CHG index: cholesterol–HDL–glucose index; TyG index: triglyceride–glucose index.

↓ Figure 5. Mediation analysis of HbA1c in the association between the CHG index and the stroke risk. Adjusted for age, gender, marital status, residence, education, smoking status, drinking status, and hypertension. CHG index: cholesterol–HDL–glucose index.

↓ Figure 6. Subgroup and interaction analyses of the association between the CHG index and the risk of stroke. Adjusted based on model 3, with the stratification variable itself excluded from adjustment. CHG index: cholesterol–HDL–glucose index.

↓ **Table 1.** Baseline Characteristics of Participants
Characteristics	Overall	Quartiles of CHG	P value
Data are presented as median (interquartile range) or n (%). BMI: body mass index; CHG index: cholesterol–HDL–glucose index; DBP: diastolic blood pressure; FBG: fasting blood glucose; HbA1c: hemoglobin A1c; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; SBP: systolic blood pressure; TC: total cholesterol; TG: triglyceride; WC: waist circumference.
Number of participants	8,376	2,145	2,119	2,050	2,062
Age, years	57.00 (51.00–63.00)	57.00 (50.00–63.00)	57.00 (51.00–63.00)	57.00 (51.00–63.00)	58.00 (52.00–64.00)	0.009
Gender, n (%)						0.088
Male	3,746 (44.72%)	1,008 (46.99%)	922 (43.51%)	914 (44.59%)	902 (43.74%)
Female	4,630 (55.28%)	1,137 (53.01%)	1,197 (56.49%)	1,136 (55.41%)	1,160 (56.26%)
Marital status, n (%)						0.026
Married	8,239 (98.36%)	2,095 (97.67%)	2,090 (98.63%)	2,018 (98.44%)	2,036 (98.74%)
Others	137 (1.64%)	50 (2.33%)	29 (1.37%)	32 (1.56%)	26 (1.26%)
Residence, n (%)						< 0.001
Rural	7,008 (83.67%)	1,889 (88.07%)	1,806 (85.23%)	1,688 (82.34%)	1,625 (78.81%)
Urban	1368 (16.33%)	256 (11.93%)	313 (14.77%)	362 (17.66%)	437 (21.19%)
Education, n (%)						0.078
Below primary school	3,907 (46.64%)	1,066 (49.70%)	975 (46.01%)	948 (46.24%)	918 (44.52%)
Primary school	1,809 (21.60%)	449 (20.93%)	477 (22.51%)	434 (21.17%)	449 (21.77%)
Middle school	1,758 (20.99%)	417 (19.44%)	449 (21.19%)	438 (21.37%)	454 (22.02%)
High school or above	902 (10.77%)	213 (9.93%)	218 (10.29%)	230 (11.22%)	241 (11.69%)
Smoking, n (%)	3,116 (37.20%)	845 (39.39%)	769 (36.29%)	762 (37.17%)	740 (35.89%)	0.082
Drinking, n (%)	3,178 (37.94%)	905 (42.19%)	787 (37.14%)	753 (36.73%)	733 (35.55%)	< 0.001
Hypertension, n (%)	2,705 (32.29%)	528 (24.62%)	600 (28.32%)	700 (34.15%)	877 (42.53%)	< 0.001
Dyslipidemia, n (%)	3,983 (47.55%)	287 (13.38%)	619 (29.21%)	1,206 (58.83%)	1,871 (90.74%)	< 0.001
Cancer, n (%)	80 (0.96%)	18 (0.84%)	22 (1.04%)	19 (0.93%)	21 (1.02%)	0.904
Heart disease, n (%)	914 (10.91%)	198 (9.23%)	221 (10.43%)	219 (10.68%)	276 (13.39%)	< 0.001
Kidney disease, n (%)	531 (6.34%)	156 (7.27%)	134 (6.32%)	115 (5.61%)	126 (6.11%)	0.160
Medication, n (%)
Lipid-lowering	395 (4.72%)	40 (1.86%)	80 (3.78%)	90 (4.39%)	185 (8.97%)	0.002
Antihypertensive	1,455 (17.37%)	259 (12.07%)	292 (13.78%)	376 (18.34%)	528 (25.61%)	0.011
WC, cm	84.20 (77.30–91.50)	79.20 (73.60–86.00)	82.40 (76.40–89.00)	86.40 (79.50–93.07)	90.00 (83.00–97.00)	< 0.001
BMI, kg/m²	23.17 (20.90–25.81)	21.50 (19.73–23.77)	22.64 (20.62–24.84)	23.86 (21.56–26.30)	24.99 (22.70–27.55)	< 0.001
SBP, mm Hg	125.67 (113.67–140.33)	122.00 (111.00–136.67)	123.67 (112.33–138.33)	127.33 (115.00–141.33)	130.50 (118.67–145.00)	< 0.001
DBP, mm Hg	74.33 (67.00–83.00)	72.33 (65.00–81.00)	73.33 (66.00–82.00)	75.00 (68.33–83.33)	77.33 (70.00–85.33)	< 0.001
TC, mg/dL	190.21 (167.40–214.95)	173.20 (155.03–195.62)	186.34 (165.46–207.60)	195.43 (173.20–216.88)	209.15 (184.79–239.31)	< 0.001
TG, mg/dL	105.32 (75.22–153.99)	72.57 (57.53–93.81)	92.04 (71.68–120.36)	121.25 (92.04–157.53)	178.77 (126.78–249.57)	< 0.001
HDL-C, mg/dL	49.48 (40.59–59.92)	63.02 (54.90–73.45)	52.96 (46.39–60.70)	45.23 (39.82–52.19)	37.89 (32.47–44.46)	< 0.001
LDL-C, mg/dL	114.82 (94.33–137.63)	96.26 (81.96–112.89)	115.21 (97.81–132.60)	124.87 (104.87–144.88)	128.74 (103.32–156.57)	< 0.001
HbA1c, %	5.10 (4.90–5.40)	5.00 (4.80–5.30)	5.10 (4.90–5.40)	5.20 (4.90–5.40)	5.30 (5.00–5.70)	< 0.001
FBG, mg/dL	100.06 (92.27–110.32)	94.32 (87.48–100.98)	99.72 (93.69–106.47)	103.50 (96.84–112.14)	106.88 (99.48–118.27)	< 0.001
CHG index	5.28 (5.03–5.55)	4.87 (4.75–4.96)	5.16 (5.10–5.23)	5.41 (5.34–5.48)	5.78 (5.65–5.98)	0.009
Stroke, n (%)	651 (7.77%)	115 (5.36%)	147 (6.94%)	179 (8.73%)	210 (10.18%)	< 0.001

↓ Table 1. Baseline Characteristics of Participants

Characteristics

Overall

Quartiles of CHG

P value

Data are presented as median (interquartile range) or n (%). BMI: body mass index; CHG index: cholesterol–HDL–glucose index; DBP: diastolic blood pressure; FBG: fasting blood glucose; HbA1c: hemoglobin A1c; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; SBP: systolic blood pressure; TC: total cholesterol; TG: triglyceride; WC: waist circumference.

Number of participants

8,376

2,145

2,119

2,050

2,062

Age, years

57.00 (51.00–63.00)

57.00 (50.00–63.00)

57.00 (51.00–63.00)

58.00 (52.00–64.00)

0.009

Gender, n (%)

0.088

Male

3,746 (44.72%)

1,008 (46.99%)

922 (43.51%)

914 (44.59%)

902 (43.74%)

Female

4,630 (55.28%)

1,137 (53.01%)

1,197 (56.49%)

1,136 (55.41%)

1,160 (56.26%)

Marital status, n (%)

0.026

Married

8,239 (98.36%)

2,095 (97.67%)

2,090 (98.63%)

2,018 (98.44%)

2,036 (98.74%)

Others

137 (1.64%)

50 (2.33%)

29 (1.37%)

32 (1.56%)

26 (1.26%)

Residence, n (%)

< 0.001

Rural

7,008 (83.67%)

1,889 (88.07%)

1,806 (85.23%)

1,688 (82.34%)

1,625 (78.81%)

Urban

1368 (16.33%)

256 (11.93%)

313 (14.77%)

362 (17.66%)

437 (21.19%)

Education, n (%)

0.078

Below primary school

3,907 (46.64%)

1,066 (49.70%)

975 (46.01%)

948 (46.24%)

918 (44.52%)

Primary school

1,809 (21.60%)

449 (20.93%)

477 (22.51%)

434 (21.17%)

449 (21.77%)

Middle school

1,758 (20.99%)

417 (19.44%)

449 (21.19%)

438 (21.37%)

454 (22.02%)

High school or above

902 (10.77%)

213 (9.93%)

218 (10.29%)

230 (11.22%)

241 (11.69%)

Smoking, n (%)

3,116 (37.20%)

845 (39.39%)

769 (36.29%)

762 (37.17%)

740 (35.89%)

0.082

Drinking, n (%)

3,178 (37.94%)

905 (42.19%)

787 (37.14%)

753 (36.73%)

733 (35.55%)

< 0.001

Hypertension, n (%)

2,705 (32.29%)

528 (24.62%)

600 (28.32%)

700 (34.15%)

877 (42.53%)

< 0.001

Dyslipidemia, n (%)

3,983 (47.55%)

287 (13.38%)

619 (29.21%)

1,206 (58.83%)

1,871 (90.74%)

< 0.001

Cancer, n (%)

80 (0.96%)

18 (0.84%)

22 (1.04%)

19 (0.93%)

21 (1.02%)

0.904

Heart disease, n (%)

914 (10.91%)

198 (9.23%)

221 (10.43%)

219 (10.68%)

276 (13.39%)

< 0.001

Kidney disease, n (%)

531 (6.34%)

156 (7.27%)

134 (6.32%)

115 (5.61%)

126 (6.11%)

0.160

Medication, n (%)

Lipid-lowering

395 (4.72%)

40 (1.86%)

80 (3.78%)

90 (4.39%)

185 (8.97%)

0.002

Antihypertensive

1,455 (17.37%)

259 (12.07%)

292 (13.78%)

376 (18.34%)

528 (25.61%)

0.011

WC, cm

84.20 (77.30–91.50)

79.20 (73.60–86.00)

82.40 (76.40–89.00)

86.40 (79.50–93.07)

90.00 (83.00–97.00)

< 0.001

BMI, kg/m²

23.17 (20.90–25.81)

21.50 (19.73–23.77)

22.64 (20.62–24.84)

23.86 (21.56–26.30)

24.99 (22.70–27.55)

< 0.001

SBP, mm Hg

125.67 (113.67–140.33)

122.00 (111.00–136.67)

123.67 (112.33–138.33)

127.33 (115.00–141.33)

130.50 (118.67–145.00)

< 0.001

DBP, mm Hg

74.33 (67.00–83.00)

72.33 (65.00–81.00)

73.33 (66.00–82.00)

75.00 (68.33–83.33)

77.33 (70.00–85.33)

< 0.001

TC, mg/dL

190.21 (167.40–214.95)

173.20 (155.03–195.62)

186.34 (165.46–207.60)

195.43 (173.20–216.88)

209.15 (184.79–239.31)

< 0.001

TG, mg/dL

105.32 (75.22–153.99)

72.57 (57.53–93.81)

92.04 (71.68–120.36)

121.25 (92.04–157.53)

178.77 (126.78–249.57)

< 0.001

HDL-C, mg/dL

49.48 (40.59–59.92)

63.02 (54.90–73.45)

52.96 (46.39–60.70)

45.23 (39.82–52.19)

37.89 (32.47–44.46)

< 0.001

LDL-C, mg/dL

114.82 (94.33–137.63)

96.26 (81.96–112.89)

115.21 (97.81–132.60)

124.87 (104.87–144.88)

128.74 (103.32–156.57)

< 0.001

HbA1c, %

5.10 (4.90–5.40)

5.00 (4.80–5.30)

5.10 (4.90–5.40)

5.20 (4.90–5.40)

5.30 (5.00–5.70)

< 0.001

FBG, mg/dL

100.06 (92.27–110.32)

94.32 (87.48–100.98)

99.72 (93.69–106.47)

103.50 (96.84–112.14)

106.88 (99.48–118.27)

< 0.001

CHG index

5.28 (5.03–5.55)

4.87 (4.75–4.96)

5.16 (5.10–5.23)

5.41 (5.34–5.48)

5.78 (5.65–5.98)

0.009

Stroke, n (%)

651 (7.77%)

115 (5.36%)

147 (6.94%)

179 (8.73%)

210 (10.18%)

< 0.001

↓ **Table 2.** Association of CHG Index and Risk of Stroke
	Case	Model 1	Model 2	Model 3
Model 1: unadjusted. Model 2: adjusted for age and gender. Model 3: adjusted for age, gender, marital status, residence, education, smoking status, drinking status, and hypertension. CHG index: cholesterol–HDL–glucose index; CI: confidence interval; HR: hazard ratio.
CHG (per 1-unit)	651	1.258 (1.065–1.486)	0.007	1.264 (1.070–1.493)	0.006	1.255 (1.038–1.518)	0.019
CHG quartile
Q1	115	Ref		Ref		Ref
Q2	147	1.358 (1.063–1.734)	0.014	1.366 (1.070–1.744)	0.012	1.378 (1.073–1.771)	0.012
Q3	179	1.414 (1.118–1.789)	0.004	1.417 (1.120–1.793)	0.004	1.447 (1.137–1.842)	0.003
Q4	210	1.473 (1.173–1.851)	< 0.001	1.481 (1.179–1.861)	< 0.001	1.463 (1.147–1.868)	0.002

↓ Table 2. Association of CHG Index and Risk of Stroke

Case

Model 1

Model 2

Model 3

HR (95% CI)

P value

HR (95% CI)

P value

HR (95% CI)

P value

Model 1: unadjusted. Model 2: adjusted for age and gender. Model 3: adjusted for age, gender, marital status, residence, education, smoking status, drinking status, and hypertension. CHG index: cholesterol–HDL–glucose index; CI: confidence interval; HR: hazard ratio.

CHG (per 1-unit)

651

1.258 (1.065–1.486)

0.007

1.264 (1.070–1.493)

0.006

1.255 (1.038–1.518)

0.019

CHG quartile

115

Ref

147

1.358 (1.063–1.734)

0.014

1.366 (1.070–1.744)

0.012

1.378 (1.073–1.771)

0.012

179

1.414 (1.118–1.789)

0.004

1.417 (1.120–1.793)

0.004

1.447 (1.137–1.842)

0.003

210

1.473 (1.173–1.851)

< 0.001

1.481 (1.179–1.861)

< 0.001

1.463 (1.147–1.868)

0.002