Cardiovascular disease is a leading cause of morbidity and mortality among the elderly population [1]. It is influenced by a combination of modifiable risk factors, such as elevated systolic blood pressure (SBP), hyperlipidemia, tobacco and alcohol consumption, unhealthy dietary habits, and physical inactivity. Additionally, age-related physiological changes – such as increased arterial stiffness and declining metabolic function—contribute to the development and progression of CVD [2], [3], [4]. This situation is further complicated by the high prevalence of comorbidities in the elderly including diabetes, chronic kidney disease, and obesity, which place additional burden on the cardiovascular system. Given these factors, effective risk management and prediction strategies are essential for improving prevention and management of cardiovascular disease in the aging population [5], [6].

The ACEF score (Age, Creatinine, and Left Ventricular Ejection Fraction) is a simplified clinical risk assessment tool originally used to predict mortality following cardiac surgery, particularly coronary artery bypass grafting (CABG) [7]. In recent years, its use has been gradually expanded to include risk stratification for a broader spectrum of cardiovascular diseases. However, a key limitation of the ACEF score is its lack of metabolic profiling, which is increasingly relevant in light of growing burden of insulin resistance-related CVDs. To address this gap, the triglyceride-glucose (TyG) index – derived from fasting triglycerides and glucose levels – has been proposed as a complementary marker. The TyG index reflects lipid-glucose dysregulation, a central hallmark in the development of atherosclerosis and endothelial dysfunction [8], [9].

The ACEF score captures elements of cardiorenal aging and hemodynamic vulnerability, while TyG reflects subclinical metabolic risk. This combination is particularly relevant for elderly populations, in whom cardiovascular disease often arises from overlapping pathophysiological processes. To date, no studies have reported the combined use of ACEF and TyG scores for predicting cardiovascular disease risk specifically in the elderly population. Given their complementary profiles, integrating ACEF and TyG may offer synergistic advantages in risk stratification.