People with prior myocardial infarction (MI) remain at high risk of mortality and recurrent cardiovascular events, and metabolic disorders after MI are closely related to residual cardiovascular risk. The cholesterol, high-density lipoprotein, and glucose (CHG) index is a recently proposed composite metabolic index calculated as Ln {[total cholesterol (mg/dL) × fasting blood glucose (mg/dL)]/[2 × high-density lipoprotein cholesterol (mg/dL)]}. In a dual-cohort observational analysis published in Cardiovascular Diabetology, the association between the CHG index and adverse outcomes was evaluated in individuals with prior MI.

The analysis included 16,959 individuals with a history of MI from the UK Biobank and 6,253 post-MI patients with coronary artery disease from Fuwai Hospital. In the UK Biobank cohort (median follow-up 13.4 years), after multivariate adjustment, compared with the lowest CHG quartile (Q1), the highest quartile (Q4) was associated with a higher all-cause mortality (HR 1.39; 95% CI, 1.33-1.41) and cardiovascular mortality (HR 1.42; 95% CI, 1.14-1.74).

In the Fuwai Hospital cohort (median follow-up 3.1 years), CHG Q4 was associated with a higher risk of major adverse cardiovascular events (HR 1.37; 95% CI, 1.17-1.61) and hard endpoints (HR 1.87; 95% CI, 1.24-2.81). Kaplan–Meier curves showed significant separation across quartiles (log-rank P < 0.05), and restricted cubic spline analyses demonstrated positive linear associations. Time-dependent receiver operating characteristic analyses showed CHG outperformed the triglyceride–glucose index model (all false discovery rate-adjusted P < 0.05).

Although the independent discriminative power of CHG was modest, the index was described as enhancing risk reclassification. Further prospective validation was noted as necessary to confirm its utility for secondary prevention risk stratification.