Metabolic Risk Factors in NonCVD Individuals and Their Trajectory Toward Cardiovascular Incidence

Background In 2019, cardiovascular disease (CVD) was the primary cause of death worldwide, responsible for approximately 18.6 million fatalities, with its prevalence and incidence continuing to rise. In Iran, CVD accounts for 46.04% of all deaths, with demographic aging and sedentary lifestyles exacerbating the burden. This study evaluated the impact of metabolic risk factors and their trajectories on CVD development in an Iranian cohort. Methods In accordance with the Tehran Lipid and Glucose Study (TLGS), this longitudinal study included 1872 adults aged 40–79 years without prior CVD at baseline. The participants were selected through multistage random cluster sampling from 1999–2018. Data were collected on demographic, lifestyle, and metabolic factors, with laboratory analyses conducted via standardized protocols. Generalized estimating equations (GEEs) were used to assess age- and sex-adjusted trajectories of metabolic indicators. Results Over the 10-year follow-up period, 117 individuals (6.3%) were diagnosed with cardiovascular disease (CVD). Baseline CVD converters presented increased age, weight, blood pressure, fasting glucose, and lipid levels, and diabetes incidence. The key metabolic risk factor trajectories included the TyG index, FPG, and SBP, which significantly increased 6 years before diagnosis. Conclusions Longitudinal trajectories of metabolic risk factors, particularly SBP, FPG, and the TyG index, demonstrated strong predictive value for CVD development years before onset, with SBP emerging as the most potent predictor. These findings emphasize the importance of early detection and preventive strategies targeting metabolic risk factors. Lifestyle modifications can significantly mitigate CVD risk, underscoring the utility of longitudinal data in understanding risk factor heterogeneity and disease progression. Greater attention should be given to patients with unstable cardiometabolic risk factors.