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Background and objective <p>Both body roundness index (BRI) and atherogenic index of plasma (AIP) are risk factors for stroke. This study seeks to ascertain whether AIP mediates the relationship between BRI and stroke risk, as well as to investigate their interaction, combined effects, and predictive value for stroke risk.</p> Methods <p>This research utilized data from the Chinese Health and Retirement Longitudinal Study (CHARLS). The main exposure variables examined were BRI and AIP. The principal outcome was the incidence of stroke.</p> Results <p>Among a nationally representative cohort of 9,036 individuals (male: 4,107; mean age: 58.5 ± 9.57 years), 785 incident stroke cases (8.7%) were documented during the observational period. Both BRI and AIP exhibited significant dose-response relationships with stroke incidence, as delineated by restricted cubic spline (RCS) analyses, which revealed pronounced nonlinear associations. Participants concurrently exhibiting elevated BRI (≥ 5.08) and AIP (≥ 0.33) demonstrated the highest risk of stroke [hazard ratio (HR) = 2.33; 95% confidence interval (CI): 1.73–3.13] relative to the reference group (BRI &lt; 3.24 and AIP &lt; 0.33). Mediation analyses further indicated that AIP mediated 10.14% and 11.68% of the association between BRI and stroke in the intermediate (4.05 ≤ BRI &lt; 5.08) and high (BRI ≥ 5.08) BRI strata, respectively. Moreover, a statistically significant multiplicative interaction between BRI and AIP was observed in relation to stroke risk (HR for interaction = 1.52, 95% CI: 1.07–2.15). Integrative predictive modeling demonstrated that the combination of BRI and AIP yielded enhanced discriminative performance for stroke risk stratification, achieving an area under the curve (AUC) of 0.598.</p> Conclusion <p>The integrated prognostic utility of BRI and AIP constitutes a valuable instrument for the enhancement of early stroke risk detection within the general populace, potentially facilitating more prompt preventive interventions. Notably, AIP elucidates over 10% of the association between BRI and stroke, underscoring a distinct metabolic pathway. Furthermore, a significant multiplicative interaction between BRI and AIP concerning stroke risk has been identified. These findings imply that public health initiatives targeting the management of visceral obesity and atherogenic dyslipidemia may play a significant role in mitigating the incidence of stroke and its concomitant disabilities.</p>

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Insights into the complex relationship between body roundness index, atherogenic index of plasma, and stroke: a nationwide prospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月16日

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  • Hao Liu,
  • Jiangping Ma,
  • Wei Yuan

摘要

Background and objective

Both body roundness index (BRI) and atherogenic index of plasma (AIP) are risk factors for stroke. This study seeks to ascertain whether AIP mediates the relationship between BRI and stroke risk, as well as to investigate their interaction, combined effects, and predictive value for stroke risk.

Methods

This research utilized data from the Chinese Health and Retirement Longitudinal Study (CHARLS). The main exposure variables examined were BRI and AIP. The principal outcome was the incidence of stroke.

Results

Among a nationally representative cohort of 9,036 individuals (male: 4,107; mean age: 58.5 ± 9.57 years), 785 incident stroke cases (8.7%) were documented during the observational period. Both BRI and AIP exhibited significant dose-response relationships with stroke incidence, as delineated by restricted cubic spline (RCS) analyses, which revealed pronounced nonlinear associations. Participants concurrently exhibiting elevated BRI (≥ 5.08) and AIP (≥ 0.33) demonstrated the highest risk of stroke [hazard ratio (HR) = 2.33; 95% confidence interval (CI): 1.73–3.13] relative to the reference group (BRI < 3.24 and AIP < 0.33). Mediation analyses further indicated that AIP mediated 10.14% and 11.68% of the association between BRI and stroke in the intermediate (4.05 ≤ BRI < 5.08) and high (BRI ≥ 5.08) BRI strata, respectively. Moreover, a statistically significant multiplicative interaction between BRI and AIP was observed in relation to stroke risk (HR for interaction = 1.52, 95% CI: 1.07–2.15). Integrative predictive modeling demonstrated that the combination of BRI and AIP yielded enhanced discriminative performance for stroke risk stratification, achieving an area under the curve (AUC) of 0.598.

Conclusion

The integrated prognostic utility of BRI and AIP constitutes a valuable instrument for the enhancement of early stroke risk detection within the general populace, potentially facilitating more prompt preventive interventions. Notably, AIP elucidates over 10% of the association between BRI and stroke, underscoring a distinct metabolic pathway. Furthermore, a significant multiplicative interaction between BRI and AIP concerning stroke risk has been identified. These findings imply that public health initiatives targeting the management of visceral obesity and atherogenic dyslipidemia may play a significant role in mitigating the incidence of stroke and its concomitant disabilities.