Cardiovascular and Cerebrovascular Diseases Column

Prognostic value of the weight-adjusted creatinine-to-cystatin C ratio for cardiovascular events in middle-aged and older adults: A nationwide prospective study based on the CHARLS cohort

  • Yunsheng ZHANG ,
  • Juan WANG ,
  • Lijing XUE ,
  • Lili JIA ,
  • Wenjuan ZHANG
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  • 1.Department of Cardiology,Tianjin Medical University General Hospital Airport Hospital,Tianjin 300308,Tianjin,China
    2.Department of Cardiology,Tianjin Medical University General Hospital,Tianjin 300052,Tianjin,China

Received date: 2026-04-11

  Revised date: 2026-06-18

  Accepted date: 2026-06-22

  Online published: 2026-08-13

Abstract

Objective To investigate the association between the weight-adjusted creatinine-to-cystatin C ratio (WCCR) and the risk of incident cardiovascular disease (CVD) among middle-aged and older adults in China. Methods Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). A total of 5 994 participants who completed the 2011 baseline survey and were followed up until 2020 were included. Data on sociodemographic characteristics, physical examinations, lifestyle factors, health status, health insurance, and biochemical indicators were collected. The WCCR was calculated using serum creatinine and cystatin C levels, adjusted for body weight, and participants were categorized into sex-specific tertiles. Cox proportional hazards regression models were used to evaluate the association between the WCCR and the risk of CVD. Results Over a median follow-up of 8.92 (7.00, 9.00) years, 1 517 cases of CVD were recorded, including 1 158 cases of heart disease and 521 cases of stroke. The incidence densities of overall CVD, heart disease, and stroke were 33.3/1 000 person-years (95%CI: 31.7 - 35.0), 25.4/1 000 person-years (95%CI: 24.0 - 26.9), and 11.4/1 000 person-years (95%CI: 10.5 - 12.5), respectively. After multivariable adjustment, compared with the lowest WCCR tertile, the highest tertile was associated with a 19.8% (95%CI: 9.2% - 29.1%) reduction in overall CVD risk and a 22.1% (95%CI: 10.3% - 32.3%) reduction in heart disease. In the highest WCCR tertile, overall CVD risk was reduced by 19.5% (95%CI: 2.6% - 33.5%) in men and 20.3% (95%CI: 6.3% - 32.3%) in women, while heart disease risk was reduced by 20.9% (95%CI: 0.6% - 37.1%) in men and 25.0% (95%CI: 9.7% - 37.8%) in women. Conclusions Among middle-aged and older adults in China, the WCCR is inversely associated with the risk of CVD. A lower WCCR is an independent risk factor for cardiovascular events, highlighting its potential utility in improving cardiovascular risk stratification and informing prevention strategies.

Cite this article

Yunsheng ZHANG , Juan WANG , Lijing XUE , Lili JIA , Wenjuan ZHANG . Prognostic value of the weight-adjusted creatinine-to-cystatin C ratio for cardiovascular events in middle-aged and older adults: A nationwide prospective study based on the CHARLS cohort[J]. The Journal of Practical Medicine, 2026 , 42(15) : 2706 -2713 . DOI: 10.3969/j.issn.1006-5725.2026.15.005

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