This study investigates the association between the atherogenic index of plasma (AIP) control level and the incidence of cardiovascular disease (CVD) in middle-aged and elderly Chinese individuals with abnormal glucose metabolism. Using data from the China Health and Retirement Longitudinal Study (CHARLS), the researchers divided AIP control levels into five classes based on k-means clustering analysis. They found that individuals with higher AIP control levels had a significantly increased risk of CVD compared to those with lower levels. After adjusting for various confounding factors, the odds ratios (ORs) for CVD incidence were 1.31, 1.38, 1.46, and 1.56 for classes 2, 3, 4, and 5, respectively. The relationship between cumulative AIP and CVD was found to be linear. Subgroup analyses showed similar results across different risk factors, with no interaction between AIP control level and subgroup variables. The study concludes that maintaining a lower AIP control level is crucial for reducing the risk of CVD in individuals with abnormal glucose metabolism. Monitoring long-term AIP changes can help identify high-risk individuals for early intervention. The study highlights the importance of AIP as a predictive biomarker for CVD in individuals with abnormal glucose metabolism.This study investigates the association between the atherogenic index of plasma (AIP) control level and the incidence of cardiovascular disease (CVD) in middle-aged and elderly Chinese individuals with abnormal glucose metabolism. Using data from the China Health and Retirement Longitudinal Study (CHARLS), the researchers divided AIP control levels into five classes based on k-means clustering analysis. They found that individuals with higher AIP control levels had a significantly increased risk of CVD compared to those with lower levels. After adjusting for various confounding factors, the odds ratios (ORs) for CVD incidence were 1.31, 1.38, 1.46, and 1.56 for classes 2, 3, 4, and 5, respectively. The relationship between cumulative AIP and CVD was found to be linear. Subgroup analyses showed similar results across different risk factors, with no interaction between AIP control level and subgroup variables. The study concludes that maintaining a lower AIP control level is crucial for reducing the risk of CVD in individuals with abnormal glucose metabolism. Monitoring long-term AIP changes can help identify high-risk individuals for early intervention. The study highlights the importance of AIP as a predictive biomarker for CVD in individuals with abnormal glucose metabolism.