Association of the remnant cholesterol inflammatory index and frailty with cardiometabolic multimorbidity among Chinese middle-aged and elderly populations: a nationwide cohort study.
- 1Changchun University of Chinese Medicine, Changchun, Jilin Province, 130000, China.
- 2Affiliated Hospital of Changchun University of Chinese Medicine, 1478 Gongnong Road, Changchun, Jilin Province, 130000, China. [email protected].
Abstract
Background
Cardiometabolic multimorbidity (CMM) is the co-occurrence of two or more cardiometabolic disorders including heart disease, diabetes and stroke. While the remnant cholesterol inflammatory index (RCII) and frailty have been independently associated with CMM, their joint association with CMM has not been fully elucidated. This study examined the joint-category associations of RCII or CumRCII with frailty in relation to incident CMM to characterize their combined epidemiological relationships with CMM risk.Methods
Based on the 2011-2020 China Health and Retirement Longitudinal Study (CHARLS), 5,779 participants were included in the final analysis. CumRCII represented time-weighted cumulative RCII exposure during 2011-2015. Kaplan-Meier curves were used to calculate CMM incidence across exposure groups. Multivariable Cox models were used to evaluate the joint-category associations of RCII or CumRCII with frailty in relation to incident CMM. Additive and multiplicative interactions were assessed separately. Restricted cubic spline models investigated potential nonlinear associations of RCII and CumRCII with CMM risk. Receiver operating characteristic curves were used in an exploratory analysis of in-sample model discrimination. The stability of the findings was assessed through subgroup and sensitivity analyses.Results
A total of 510 participants were diagnosed with CMM. Higher RCII or CumRCII in combination with frailty was associated with increased CMM incidence. RCII and CumRCII exhibited positive nonlinear associations with CMM risk. Compared with individuals with low RCII and without frailty, those with concurrent high RCII and frailty showed a higher risk of incident CMM (HR = 2.622, 95% CI 1.972-3.488). Similar results were observed for CumRCII (above optimal threshold) combined with frailty (HR = 2.849, 95% CI 2.178-3.726). However, additive and multiplicative interaction analyses did not remain statistically significant after full adjustment. The model incorporating CumRCII and frailty had a modestly higher in-sample AUC than the CumRCII-only model (0.757 vs. 0.740; ΔAUC = 0.017; DeLong P < 0.001). Subgroup and sensitivity analyses supported the robustness of the main findings.Conclusion
In joint-category Cox analyses, participants with concurrent elevated RCII or CumRCII and frailty showed the highest observed risk of incident CMM. These findings suggest that lipid-inflammatory burden and frailty may represent complementary dimensions of CMM risk.
Related
- Triglyceride–HDL cholesterol–glucose body index and cardiometabolic multimorbidity: evidence from a national longitudinal cohort and a subplateau health-screening population
- Predictive value of the combined cholesterol, high-density lipoprotein, glucose and frailty indices for cardiometabolic multimorbidity incidence: evidence from a national prospective cohort study
- Longitudinal joint trajectories of the dietary inflammatory index and physical activity and risk of incident cardiometabolic multimorbidity among women: evidence from the China Health and Nutrition Survey
- Remnant-cholesterol-inflammatory-index as a novel predictor of cardiometabolic risk and cardiovascular mortality in elderly patients with severe aortic stenosis
- Association of TyG-related indices with cardiometabolic multimorbidity across early cardiovascular-kidney-metabolic syndrome stages 0–3: a prospective cohort study
BibTeX
@article{zhao2026association,
title = {{Association of the remnant cholesterol inflammatory index and frailty with cardiometabolic multimorbidity among Chinese middle-aged and elderly populations: a nationwide cohort study.}},
author = {Shiyuan Zhao and Zhenhan Wang and Liping Chang},
journal = {BMC cardiovascular disorders},
year = {2026},
month = jul,
doi = {10.1186/s12872-026-06356-w},
url = {https://europepmc.org/article/MED/42902143},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Association of the remnant cholesterol inflammatory index and frailty with cardiometabolic multimorbidity among Chinese middle-aged and elderly populations: a nationwide cohort study.
AU - Shiyuan Zhao
AU - Zhenhan Wang
AU - Liping Chang
PY - 2026
DA - 2026/07/01
JO - BMC cardiovascular disorders
DO - 10.1186/s12872-026-06356-w
UR - https://europepmc.org/article/MED/42902143
AB - Background Cardiometabolic multimorbidity (CMM) is the co-occurrence of two or more cardiometabolic disorders including heart disease, diabetes and stroke. While the remnant cholesterol inflammatory index (RCII) and frailty have been independently associated with CMM, their joint association with CMM has not been fully elucidated. This study examined the joint-category associations of RCII or CumRCII with frailty in relation to incident CMM to characterize their combined epidemiological relationships with CMM risk.Methods Based on the 2011-2020 China Health and Retirement Longitudinal Study (CHARLS), 5,779 participants were included in the final analysis. CumRCII represented time-weighted cumulative RCII exposure during 2011-2015. Kaplan-Meier curves were used to calculate CMM incidence across exposure groups. Multivariable Cox models were used to evaluate the joint-category associations of RCII or CumRCII with frailty in relation to incident CMM. Additive and multiplicative interactions were assessed separately. Restricted cubic spline models investigated potential nonlinear associations of RCII and CumRCII with CMM risk. Receiver operating characteristic curves were used in an exploratory analysis of in-sample model discrimination. The stability of the findings was assessed through subgroup and sensitivity analyses.Results A total of 510 participants were diagnosed with CMM. Higher RCII or CumRCII in combination with frailty was associated with increased CMM incidence. RCII and CumRCII exhibited positive nonlinear associations with CMM risk. Compared with individuals with low RCII and without frailty, those with concurrent high RCII and frailty showed a higher risk of incident CMM (HR = 2.622, 95% CI 1.972-3.488). Similar results were observed for CumRCII (above optimal threshold) combined with frailty (HR = 2.849, 95% CI 2.178-3.726). However, additive and multiplicative interaction analyses did not remain statistically significant after full adjustment. The model incorporating CumRCII and frailty had a modestly higher in-sample AUC than the CumRCII-only model (0.757 vs. 0.740; ΔAUC = 0.017; DeLong P < 0.001). Subgroup and sensitivity analyses supported the robustness of the main findings.Conclusion In joint-category Cox analyses, participants with concurrent elevated RCII or CumRCII and frailty showed the highest observed risk of incident CMM. These findings suggest that lipid-inflammatory burden and frailty may represent complementary dimensions of CMM risk.
SN - 1471-2261
ER -