{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:59:00Z","timestamp":1780894740057,"version":"3.54.1"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Although the role of AIP in predicting cardiovascular disease has been recognized, its association with all-cause mortality in different blood pressure status populations remains unclear. This study aims to investigate the predictive ability of the Atherogenic Index of Plasma (AIP) and its modified indices for all-cause mortality in rural low-income populations with different blood pressure statuses and compare them with the Triglyceride-Glucose (TyG) index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 3,924 rural low-income participants were included in this study. Sociodemographic variables, lifestyle habits, anthropometric measurements, and biochemical markers were systematically recorded. Cox regression and restricted cubic spline (RCS) analyses were used to explore the linear and non-linear associations between TyG and AIP and their modified indices (TyG-BMI, TyG-WHtR, TyG-WC, TyG-WWI, AIP-BMI, AIP-WHtR, AIP-WC, AIP-WWI) and all-cause mortality. Kaplan\u2013Meier survival curves were plotted. Time-dependent receiver operating characteristic (ROC) curves were constructed separately in the hypertensive and non-hypertensive groups to evaluate and compare the predictive ability of TyG and AIP and related indices for all-cause mortality. Additionally, subgroup analyses were performed based on age, gender, and blood glucose status, and mediation analyses were conducted for fasting blood glucose and LDL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During a median follow-up of 8.82 years, 1,024 cases of all-cause mortality were recorded. After adjusting for confounders, in the hypertensive group, TyG and AIP and their modified indices were significantly negatively associated with all-cause mortality (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Among these, the AIP and its modified index demonstrated stronger protective associations compared to the TyG-based index. Specifically, a one-unit increase in AIP-WHtR (range: \u22121.47 to 1.68) was associated with a 79% reduction in the risk of all-cause mortality (HR: 0.21, 95% CI: 0.18\u20130.25,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001); a one-unit increase in AIP (range: \u22122.41 to 2.90) was associated with a 57% reduction in the risk of all-cause mortality (HR: 0.43, 95% CI: 0.39\u20130.47,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). However, in the non-hypertensive group, no significant associations were observed between TyG and AIP and their modified indices and all-cause mortality (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05). In the hypertensive group, TyG and AIP and their modified indices had a non-linear association with all-cause mortality, characterized by a rapid initial decline followed by a plateau. Compared with TyG and its modified indices, AIP and its modified indices showed better predictive ability. Subgroup analyses further confirmed the robustness of the related conclusions, and no mediating effects of fasting blood glucose and LDL were found.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>AIP and its modified indices are significantly negatively associated with all-cause mortality in hypertensive individuals and have a non-linear relationship. No such association was found in the non-hypertensive group. AIP and its modified indices have better predictive ability for all-cause mortality than TyG and its modified indices. These findings provide a scientific basis for the prevention and treatment of cardiovascular diseases in rural areas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1747068","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:23:23Z","timestamp":1780892603000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Blood pressure\u2013stratified associations of the atherogenic index of plasma with all-cause mortality: a 10-year rural cohort study in China"],"prefix":"10.3389","volume":"13","author":[{"given":"Juan","family":"Hao","sequence":"first","affiliation":[{"name":"Department of Neurology, Tianjin Medical University General Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiyu","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Tianjin Jizhou People\u2019s Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenxi","family":"Fan","sequence":"additional","affiliation":[{"name":"Institute of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People\u2019s Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mo","family":"Lv","sequence":"additional","affiliation":[{"name":"Standardization Office of Palliative Care, Tianjin Jizhou People\u2019s Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiahao","family":"Wu","sequence":"additional","affiliation":[{"name":"First Clinical Medical College, Tianjin Medical University","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Tianjin Medical University General Hospital","place":["Tianjin, China"]},{"name":"Institute of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People\u2019s Hospital","place":["Tianjin, China"]},{"name":"Laboratory of Epidemiology, Tianjin Neurological Institute","place":["Tianjin, China"]},{"name":"Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunsheng","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Tianjin Medical University General Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianjia","family":"Ning","sequence":"additional","affiliation":[{"name":"Department of Neurology, Tianjin Medical University General Hospital","place":["Tianjin, China"]},{"name":"Institute of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People\u2019s Hospital","place":["Tianjin, China"]},{"name":"Laboratory of Epidemiology, Tianjin Neurological Institute","place":["Tianjin, China"]},{"name":"Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Li","sequence":"additional","affiliation":[{"name":"Institute of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People\u2019s Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1093\/qjmed\/hcaf022","article-title":"Global burden of cardiovascular diseases and its risk factors, 1990-2021: a systematic analysis for the global burden of disease study 2021","volume":"118","author":"Tan","year":"2025","journal-title":"QJM"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1093\/eurjpc\/zwae281","article-title":"Global burden of cardiovascular diseases: projections from 2025 to 2050","volume":"32","author":"Chong","year":"2025","journal-title":"Eur J Prev Cardiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1038\/s41392-022-01073-0","article-title":"Trends in insulin resistance: insights into mechanisms and therapeutic strategy","volume":"7","author":"Li","year":"2022","journal-title":"Signal Transduct Target Ther"},{"key":"B4","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1186\/s12933-023-01934-0","article-title":"Nonlinear relationship between atherogenic index of plasma and the risk of prediabetes: a retrospective study based on Chinese adults","volume":"22","author":"Zheng","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1186\/s12933-025-02826-1","article-title":"The association between triglyceride-glucose index and all-cause\/cardiovascular mortality in patients with different glucose metabolism statuses","volume":"24","author":"Liu","year":"2025","journal-title":"Cardiovasc Diabetol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/s12933-022-01456-1","article-title":"Cumulative triglyceride-glucose index is a risk for CVD: a prospective cohort study","volume":"21","author":"Cui","year":"2022","journal-title":"Cardiovasc Diabetol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1186\/s12933-024-02163-9","article-title":"Associations of the triglyceride-glucose index and atherogenic index of plasma with the severity of new-onset coronary artery disease in different glucose metabolic states","volume":"23","author":"Wu","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1186\/s12933-025-02890-7","article-title":"Does diabetes status modify the association between the triglyceride-glucose index and major adverse cardiovascular events in patients with coronary heart disease? A systematic review and meta-analysis of longitudinal cohort studies","volume":"24","author":"Xu","year":"2025","journal-title":"Cardiovasc Diabetol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e984","DOI":"10.1161\/CIR.0000000000000973","article-title":"Obesity and cardiovascular disease: a scientific statement from the American Heart Association","volume":"143","author":"Powell-Wiley","year":"2021","journal-title":"Circulation"},{"key":"B10","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1186\/s12933-022-01670-x","article-title":"Association between abdominal obesity indices and risk of cardiovascular events in Chinese populations with type 2 diabetes: a prospective cohort study","volume":"21","author":"Qiao","year":"2022","journal-title":"Cardiovasc Diabetol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1264","DOI":"10.1111\/dom.15424","article-title":"Associations between Chinese visceral adiposity index and risks of all-cause and cause-specific mortality: a population-based cohort study","volume":"26","author":"Wu","year":"2024","journal-title":"Diabetes Obes Metab"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1038\/s41440-019-0284-9","article-title":"The Japanese society of hypertension guidelines for the management of hypertension (JSH 2019)","volume":"42","author":"Umemura","year":"2019","journal-title":"Hypertens Res"},{"key":"B13","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1097\/MNH.0b013e328350a50f","article-title":"New insights into mechanisms of hypertension","volume":"21","author":"Touyz","year":"2012","journal-title":"Curr Opin Nephrol Hypertens"},{"key":"B14","first-page":"i","article-title":"Obesity: preventing and managing the global epidemic. Report of a WHO consultation","volume":"894","year":"2000","journal-title":"World Health Organ Tech Rep Ser"},{"key":"B15","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1186\/s12902-025-02099-5","article-title":"TyG-ABSI as a novel metabolic obesity indicator for carotid plaque: an explainable machine learning study using SHAP in low-income population","volume":"25","author":"Hao","year":"2025","journal-title":"BMC Endocr Disord"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1334","DOI":"10.1161\/HYPERTENSIONAHA.120.15026","article-title":"2020 International society of hypertension global hypertension practice guidelines","volume":"75","author":"Unger","year":"2020","journal-title":"Hypertension"},{"key":"B17","doi-asserted-by":"publisher","first-page":"S15","DOI":"10.2337\/dc21-S002","article-title":"2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2021","volume":"44","year":"2021","journal-title":"Diabetes Care"},{"key":"B18","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1089\/met.2008.0034","article-title":"The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects","volume":"6","author":"Simental-Mend\u00eda","year":"2008","journal-title":"Metab Syndr Relat Disord"},{"key":"B19","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1016\/S0009-9120(01)00263-6","article-title":"The plasma parameter log (TG\/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER(HDL))","volume":"34","author":"Dobi\u00e1sov\u00e1","year":"2001","journal-title":"Clin Biochem"},{"key":"B20","doi-asserted-by":"publisher","first-page":"16753","DOI":"10.1038\/s41598-018-35073-4","article-title":"A novel adiposity index as an integrated predictor of cardiometabolic disease morbidity and mortality","volume":"8","author":"Park","year":"2018","journal-title":"Sci Rep"},{"key":"B21","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1186\/s12967-022-03678-z","article-title":"Combined association of triglyceride-glucose index and systolic blood pressure with all-cause and cardiovascular mortality among the general population","volume":"20","author":"Yu","year":"2022","journal-title":"J Transl Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1469055","DOI":"10.3389\/fendo.2024.1469055","article-title":"The associations of the triglyceride-glucose index and its combination with blood pressure on cardiovascular and all-cause mortality in hypertension: a national study","volume":"15","author":"Xu","year":"2024","journal-title":"Front Endocrinol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"12071","DOI":"10.1038\/s41598-025-96202-4","article-title":"The relationship between the triglyceride-glucose (TyG) index and all-cause mortality in ICU patients with primary hypertension: a retrospective study","volume":"15","author":"Ding","year":"2025","journal-title":"Sci Rep"},{"key":"B24","doi-asserted-by":"publisher","first-page":"778038","DOI":"10.3389\/fcvm.2021.778038","article-title":"A non-linear association of triglyceride glycemic index with cardiovascular and all-cause mortality among patients with hypertension","volume":"8","author":"Zhou","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"B25","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s12933-022-01511-x","article-title":"Triglyceride-glucose index as a marker in cardiovascular diseases: landscape and limitations","volume":"21","author":"Tao","year":"2022","journal-title":"Cardiovasc Diabetol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1016\/j.cjca.2020.02.066","article-title":"Role of hyperinsulinemia and insulin resistance in hypertension: metabolic syndrome revisited","volume":"36","author":"da Silva","year":"2020","journal-title":"Can J Cardiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"5814","DOI":"10.3390\/ijms23105814","article-title":"Hypertension in patients with insulin resistance: etiopathogenesis and management in children","volume":"23","author":"Tagi","year":"2022","journal-title":"Int J Mol Sci"},{"key":"B28","doi-asserted-by":"publisher","first-page":"2601","DOI":"10.1172\/JCI118709","article-title":"Obesity\/insulin resistance is associated with endothelial dysfunction. Implications for the syndrome of insulin resistance","volume":"97","author":"Steinberg","year":"1996","journal-title":"J Clin Invest"},{"key":"B29","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1007\/s40292-020-00408-8","article-title":"Insulin resistance the hinge between hypertension and type 2 diabetes","volume":"27","author":"Mancusi","year":"2020","journal-title":"High Blood Press Cardiovasc Prev"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1807","DOI":"10.2337\/db05-1543","article-title":"Hyperglycemia stimulates coagulation, whereas hyperinsulinemia impairs fibrinolysis in healthy humans","volume":"55","author":"Stegenga","year":"2006","journal-title":"Diabetes"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1007\/s00125-006-0197-4","article-title":"Molecular mechanisms involved in the resistance of fibrin to clot lysis by plasmin in subjects with type 2 diabetes mellitus","volume":"49","author":"Dunn","year":"2006","journal-title":"Diabetologia"},{"key":"B32","doi-asserted-by":"publisher","first-page":"7197054","DOI":"10.1155\/2020\/7197054","article-title":"Using the atherogenic index of plasma to estimate the prevalence of ischemic stroke within a general population in a rural area of China","volume":"2020","author":"Wang","year":"2020","journal-title":"Biomed Res Int"},{"key":"B33","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1186\/s12933-024-02370-4","article-title":"Association between atherogenic index of plasma and all-cause mortality and specific-mortality: a nationwide population-based cohort study","volume":"23","author":"You","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1186\/s12933-025-02742-4","article-title":"Association between atherogenic index of plasma with all-cause and cardiovascular mortality in individuals with cardiovascular-kidney-metabolic syndrome","volume":"24","author":"Zheng","year":"2025","journal-title":"Cardiovasc Diabetol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1186\/s12872-023-03451-0","article-title":"The association between atherogenic index of plasma and all-cause mortality and cardiovascular disease-specific mortality in hypertension patients: a retrospective cohort study of NHANES","volume":"23","author":"Duiyimuhan","year":"2023","journal-title":"BMC Cardiovasc Disord"},{"key":"B36","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1186\/s12944-025-02586-7","article-title":"Atherogenic index of plasma and triglyceride-glucose index mediate the association between stroke and all-cause mortality: insights from the lipid paradox","volume":"24","author":"Qian","year":"2025","journal-title":"Lipids Health Dis"},{"key":"B37","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1194\/jlr.P011668","article-title":"Cholesterol esterification and atherogenic index of plasma correlate with lipoprotein size and findings on coronary angiography","volume":"52","author":"Dobi\u00e1sov\u00e1","year":"2011","journal-title":"J Lipid Res"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1747068\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:23:24Z","timestamp":1780892604000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1747068\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,8]]},"references-count":37,"alternative-id":["10.3389\/fcvm.2026.1747068"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1747068","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,8]]},"article-number":"1747068"}}