Association of C-reactive protein-triglyceride glucose index with the incidence and mortality of cardiovascular disease: a retrospective cohort study

Abstract

Background: The C-reactive protein-triglyceride-glucose index (CTI) has emerged as an innovative composite marker for evaluating metabolic-inflammatory dysregulation, integrating markers of insulin resistance and systemic inflammation. However, the association between CTI and cardiovascular disease (CVD) or its mortality has rarely been studied. This study sought to examine CTI's associations with CVD mortality, CVD incidence, and all-cause mortality.

Methods: This study included 8,679 adults from the National Health and Nutrition Examination Survey (NHANES) 2001-2010, 2015-2018. The CTI was derived as: 0.412* Ln (CRP [mg/L]) + Ln (TG [mg/dl] × FPG [mg/dl])/2, with participants categorized into quartiles. We employed Kaplan-Meier curves, cox proportional hazards model, logistic regression analyses, and restricted cubic spline (RCS) to evaluate CTI's associations with CVD mortality, total CVD incidence, and all-cause mortality across sex-stratified, age-specific, and glycemic subgroups.

Results: In this study, CTI was significantly and positively associated with CVD mortality, total CVD incidence, and all-cause mortality. CTI significantly predicted both CVD mortality (HR 2.28 [1.69-3.24]) and all-cause mortality (HR 2.14 [1.76-2.55]). Additionally, the CTI index correlated with the risk of total CVD (OR 2.85, 95% CI 2.32-3.52), congestive heart failure (OR 3.66, 95% CI 2.46-5.35), coronary heart disease (OR 2.82, 95% CI 1.95-3.97), angina pectoris (OR 2.85, 95% CI 1.89-4.22), heart attack (OR 2.59, 95% CI 1.89-3.52), and stroke (OR 2.86, 95% CI 2.00-3.85). Specifically, the association was similar between male and female, and similar in young participants and elderly participants. In different glycemic status, high levels of CTI were found to be linked to an increased risk of CVD in individuals without diabetes mellitus (DM). However, this association was not observed in individuals with DM.

Conclusions: Our analysis revealed that elevated CTI levels were significantly associated with CVD incidence and mortality. CTI may emerge as a unique predictive marker for CVD risk.

Keywords: All-cause mortality; C-reactive protein-triglyceride glucose index; Cardiovascular disease; Cardiovascular disease mortality; NHANES.

Fig. 1

Flowchart depicting the participants’ selection

Fig. 2

Forest plot of the CTI association with CVD mortality, total CVD, and all-cause mortality using logistic regression model and Cox proportional hazards model

Fig. 3

Associations between CTI with CVD mortality, total CVD, congestive heart failure, coronary heart disease, angina pectoris, heart attack, and stroke were evaluated by RCS after adjustment for the covariables. The solid lines correspond to the central estimates, and the shaded regions indicate the 95% confidence intervals. A CVD mortality; B Total CVD; C All-cause mortality; D Congestive heart failure; E Coronary heart disease; F Angina pectoris; G Heart attack; H Stroke

Fig. 4

Forest plot of the CTI association with CVD mortality, total CVD, and all-cause mortality using logistic regression model and Cox proportional hazards model in subgroups. A Gender; B Age; C Glycemic status

Fig. 4

Forest plot of the CTI association with CVD mortality, total CVD, and all-cause mortality using logistic regression model and Cox proportional hazards model in subgroups. A Gender; B Age; C Glycemic status

Fig. 5

The Kaplan–Meier curves analysis depicts the cumulative incidence of CVD mortality and all-cause mortality across the CTI index quartiles. A All-cause mortality; B CVD mortality

Fig. 6

Comparison of the predictive value of CTI index for total CVD, congestive heart failure, coronary heart disease, angina pectoris, heart attack, and stroke. a congestive heart failure; b coronary heart disease; c angina pectoris; d heart attack; e stroke; f Total CVD