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Background <p>The Zhejiang University (ZJU) Index, a composite metabolic indicator incorporating body mass index (BMI), fasting plasma glucose (FPG), triglycerides (TG), and alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio, is associated with abnormalities like dyslipidemia and glucose intolerance. Yet its clinical significance in cardiovascular disease (CVD) is underinvestigated, and this study aims to clarify its associations with prevalent CVD, all-cause mortality, and CVD mortality.</p> Methods <p>The study included 18,609 adults from the National Health and Nutrition Examination Survey (NHANES) spanning 1999–2018. Associations of the ZJU Index with prevalent CVD were evaluated using multivariable Logistic regression. Associations with all-cause mortality and CVD mortality were assessed using multivariable Cox proportional hazards regression. Restricted cubic spline (RCS) regression and ROC curve analyses were further used to explore non-linear relationships and predictive performance, respectively. Sensitivity analyses, which included excluding participants who died within 2 years and those with baseline CVD, confirmed the robustness of the findings.</p> Results <p>Among 18,609 participants, 2,121 had CVD (9.0% weighted prevalence). Logistic regression showed a positive association of the ZJU Index with prevalent CVD risk: after full adjustment, a 1-unit increase was linked to a 2% higher risk (OR = 1.02, 95% CI 1.01–1.03, <i>P</i> &lt; 0.001), and participants in the highest quartile (Q4) had a 50% higher risk than those in the lowest quartile (Q1) (OR = 1.50, 95% CI 1.22–1.84, <i>P</i> &lt; 0.001). Significant non-linearity between the ZJU Index and prevalent CVD was confirmed (<i>P</i> &lt; 0.001). Over a median 71-month follow-up (36–121 months), 2,752 all-cause deaths (11.1% weighted rate) and 934 CVD deaths (3.4% weighted rate) occurred. After full adjustment, the association persisted for CVD mortality (Q4 vs. Q1: HR = 1.30, 95% CI 1.03–1.63, <i>P</i> = 0.027). Restricted cubic spline (RCS) analysis revealed that the ZJU Index had a U-shaped relationship with all-cause mortality and a J-shaped relationship with CVD mortality (both <i>P</i> &lt; 0.001). Sensitivity analyses supported the robustness of these findings.</p> Conclusions <p>In conclusion, whether analyzed as a continuous or categorical variable, a higher ZJU Index is significantly associated with higher risks of CVD and CVD mortality, while it shows a U-shaped relationship with all-cause mortality. This indicates that the ZJU Index holds potential as a CVD risk stratification tool to identify high-risk individuals and guide targeted interventions. However, its utility as a CVD screening tool requires further validation to confirm optimal cut-offs and compatibility with existing protocols.</p> Graphical Abstract <p></p>

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Associations of the Zhejiang University (ZJU) index with cardiovascular diseases and mortality among US adults: a national cohort study

  • 期刊论文

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  • 发表日期：

    2025年11月28日

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  • Zhenzhen Mo,
  • Bilian Chen,
  • Minyi Wu

摘要

Background

The Zhejiang University (ZJU) Index, a composite metabolic indicator incorporating body mass index (BMI), fasting plasma glucose (FPG), triglycerides (TG), and alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio, is associated with abnormalities like dyslipidemia and glucose intolerance. Yet its clinical significance in cardiovascular disease (CVD) is underinvestigated, and this study aims to clarify its associations with prevalent CVD, all-cause mortality, and CVD mortality.

Methods

The study included 18,609 adults from the National Health and Nutrition Examination Survey (NHANES) spanning 1999–2018. Associations of the ZJU Index with prevalent CVD were evaluated using multivariable Logistic regression. Associations with all-cause mortality and CVD mortality were assessed using multivariable Cox proportional hazards regression. Restricted cubic spline (RCS) regression and ROC curve analyses were further used to explore non-linear relationships and predictive performance, respectively. Sensitivity analyses, which included excluding participants who died within 2 years and those with baseline CVD, confirmed the robustness of the findings.

Results

Among 18,609 participants, 2,121 had CVD (9.0% weighted prevalence). Logistic regression showed a positive association of the ZJU Index with prevalent CVD risk: after full adjustment, a 1-unit increase was linked to a 2% higher risk (OR = 1.02, 95% CI 1.01–1.03, P < 0.001), and participants in the highest quartile (Q4) had a 50% higher risk than those in the lowest quartile (Q1) (OR = 1.50, 95% CI 1.22–1.84, P < 0.001). Significant non-linearity between the ZJU Index and prevalent CVD was confirmed (P < 0.001). Over a median 71-month follow-up (36–121 months), 2,752 all-cause deaths (11.1% weighted rate) and 934 CVD deaths (3.4% weighted rate) occurred. After full adjustment, the association persisted for CVD mortality (Q4 vs. Q1: HR = 1.30, 95% CI 1.03–1.63, P = 0.027). Restricted cubic spline (RCS) analysis revealed that the ZJU Index had a U-shaped relationship with all-cause mortality and a J-shaped relationship with CVD mortality (both P < 0.001). Sensitivity analyses supported the robustness of these findings.

Conclusions

In conclusion, whether analyzed as a continuous or categorical variable, a higher ZJU Index is significantly associated with higher risks of CVD and CVD mortality, while it shows a U-shaped relationship with all-cause mortality. This indicates that the ZJU Index holds potential as a CVD risk stratification tool to identify high-risk individuals and guide targeted interventions. However, its utility as a CVD screening tool requires further validation to confirm optimal cut-offs and compatibility with existing protocols.

Graphical Abstract