Background Atherosclerosis have been implicated in cardiovascular disease (CVD) risks, and whether frailty played a mediating role in this association was unclear. Objectives This study aimed to assess the associations of cumulative atherosclerosis index of plasma (CumAIP) exposure with incidence of CVD and evaluate the mediating role of frailty. Methods The study analyzed data from the China Health and Retirement Longitudinal Study (CHARLS) cohort. Triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) were extracted to calculate the CumAIP. Frailty was assessed using the frailty index (FI). CVD events were confirmed based on medical history. Cox proportional hazards, linear regression, and restricted cubic spline (RCS) models were employed, along with mediation analysis. Results Increased atherosclerosis was associated with increased risks of CVD. In the fully adjusted Cox model, compared to the CumAIP Q1 group, the HR and 95% confidence intervals (CI) of the Q3–Q4 groups in model 3 were 1.320 (95% CI 1.104–1.579) and 1.396 (95% CI 1.164–1.675), respectively. The CumAIP level demonstrated a positive association with frailty, with β (95% CI) of 0.016 (95% CI 0.003–0.010) in response to per 0.1 increment in CumAIP. The frailty mediated the association between atherosclerosis and CVD risk. The proportions of mediation were 11.81% between CumAIP and CVD. Subgroup and sensitivity analyses confirmed the robustness of these findings. Conclusions Atherosclerosis was linked to increased risks of CVD. The frailty partially mediated the association between atherosclerosis and CVD. These results highlighted the significance of interventions targeting atherosclerosis and frailty in CVD prevention and management. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> Key Points • This study found a significant association between higher CumAIP levels and increased CVD risk, highlighting the impact of long-term lipid abnormalities on cardiovascular health. • Frailty played as a partial mediator in the link between CumAIP and CVD, highlighting its importance in the progression from atherosclerosis to CVD. </entry> </row> </tbody> </tgroup> </Table>

Cumulative atherogenic index of plasma exposure and cardiovascular disease risk: the mediating role of frailty in a Chinese middle-aged and elderly population

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发表日期：

2025年10月10日

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Yan Lin,
Xiaocan Jia,
Xuezhong Shi,
Jingwen Fan,
Jiaqi Sun,
Yishuo Gao,
Yongli Yang

摘要

Background

Atherosclerosis have been implicated in cardiovascular disease (CVD) risks, and whether frailty played a mediating role in this association was unclear.

Objectives

This study aimed to assess the associations of cumulative atherosclerosis index of plasma (CumAIP) exposure with incidence of CVD and evaluate the mediating role of frailty.

Methods

The study analyzed data from the China Health and Retirement Longitudinal Study (CHARLS) cohort. Triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) were extracted to calculate the CumAIP. Frailty was assessed using the frailty index (FI). CVD events were confirmed based on medical history. Cox proportional hazards, linear regression, and restricted cubic spline (RCS) models were employed, along with mediation analysis.

Results

Increased atherosclerosis was associated with increased risks of CVD. In the fully adjusted Cox model, compared to the CumAIP Q1 group, the HR and 95% confidence intervals (CI) of the Q3–Q4 groups in model 3 were 1.320 (95% CI 1.104–1.579) and 1.396 (95% CI 1.164–1.675), respectively. The CumAIP level demonstrated a positive association with frailty, with β (95% CI) of 0.016 (95% CI 0.003–0.010) in response to per 0.1 increment in CumAIP. The frailty mediated the association between atherosclerosis and CVD risk. The proportions of mediation were 11.81% between CumAIP and CVD. Subgroup and sensitivity analyses confirmed the robustness of these findings.

Conclusions

Atherosclerosis was linked to increased risks of CVD. The frailty partially mediated the association between atherosclerosis and CVD. These results highlighted the significance of interventions targeting atherosclerosis and frailty in CVD prevention and management.

Key Points

• This study found a significant association between higher CumAIP levels and increased CVD risk, highlighting the impact of long-term lipid abnormalities on cardiovascular health.

• Frailty played as a partial mediator in the link between CumAIP and CVD, highlighting its importance in the progression from atherosclerosis to CVD.