Abstract:Objective To explore the relationship between cardiac metabolic index (CMI) and stroke in middle-aged and elderly individuals based on a large sample cohort study. Methods Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018. Multivariate logistic regression models were developed to explore the association between CMI and stroke, while restricted cubic spline (RCS) model was used to examine possible non-linear associations. Results A total of 6198 study participants were included in this study, with 349 strokes occurring during the 7-year follow-up and a baseline CMI level of 0.98 (0.61, 1.51). Logistic regression results showed that for each quartile increase in CMI, the prevalence risk of a new stroke was increased by 36.7% (OR=1.367, 95%CI: 1.188-1.574) and there was a cumulative effect (P for trend＜0.01). RCS showed that there was a dose-response relationship between CMI and stroke (P＜0.01), and it was a non-linear relationship (P_non-linear＜0.01). Conclusion High levels of CMI have a high predictive value for the occurrence of stroke.