Association of Cardiometabolic Index with Cardiometabolic Continuum Across Healthy, Type 2 Diabetes Mellitus and Cardiovascular Disease Groups in Rural South India.

Abstract

Background: The Cardiometabolic index (CMI), a composite marker that combines atherogenic dyslipidemia, mainly triglyceride to high density lipoprotein cholesterol (TG/HDL-C) ratio, with central adiposity, is determined by the waist to height ratio (WHtR). The objective of this study was to examine the diagnostic performance, gender specificity and progressive increase of CMI throughout the cardiometabolic disease continuum (Healthy controls and the study groups).
Methodology: A total of 250 participants were included in this cross-sectional study, categorized into three study groups- Healthy controls (n=50), Type 2 Diabetes mellitus (n=100) and Type 2 diabetes with cardiovascular complications(n=100). Standard biochemical and anthropometrics were recorded. The Kruskal- Walli’s test with post hoc pairwise comparison was used to examine the differences in CMI across the study groups. The main and interactive effects of clinical groups and gender on CMI values were assessed by two-way ANOVA. The disease severity was modeled using linear regression and the diagnostic performance of CMI was evaluated using Receiver Operating Characteristic (ROC) curve analysis.
Results: Study participants were grouped into three study categories, across the groups progressive increase in CMI was exhibited, ranging from 1.13 ± 0.56 in healthy controls to 3.29 ± 2.56 and 4.48 ±2.09 in T2DM and T2DM +CVD groups respectively (x2= 117.9, df=2, p<0.001) also significant difference across all groups (p<0.001) was observed. A two-way ANOVA demonstrated that clinical group showed significant effect on CMI (F=10.368, p<0.001), but neither gender nor the group x gender interaction were significant. Linear regression showed an independent positive association between CMI and disease severity (β=1.60, p<0.001; R2= 0.244). ROC analysis of controls vs T2DM (AUC=0.908), and T2DM+ CVD vs controls (AUC=0.986), exhibited significant discrimination between the groups. Whereas in T2DM vs T2DM+CVD, CMI demonstrated a moderate degree of discrimination (AUC=0.721).
Conclusion: CMI is progressively rising and gender independent biomarker that effectively mirrors clinical severity across cardiometabolic continuum by providing excellent sensitivity and specificity in detecting diabetic and macrovascular complications. Additionally, further clinical follow up finds uncomplicated T2DM patients at imminent risk of cardiovascular complications, enabling timely, targeted cardioprotective therapeutic interventions.