This study evaluated the predictive performance of ten IR surrogate indexes (TyG, TyG-BMI, TyG-WC, TyG-WHtR, METS-IR, AIP, TyHGB, CTI, eGDR, CVAI) for new-onset CVD in Chinese patients with prediabetes or diabetes, aiming to identify the most effective index for cardiovascular risk stratification.<h4>Methods</h4>This longitudinal cohort study analyzed 3,532 middle-aged and elderly participants from the China Health and Retirement Longitudinal Study (CHARLS) baseline (Wave 1), with incident CVD events assessed at follow-up (Wave 4). The gene discussed is AIP; the disease is prediabetes syndrome.