Sun Yu, Guo Yu, Ma Shiyin, Mao Zhi, Meng Deguo, Xuan Kaige, Lu Ruogu, Pan Xudong, Zhu Xiaoyan
Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
Cardiovasc Diabetol. 2025 Aug 1;24(1):313. doi: 10.1186/s12933-025-02835-0.
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.
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.
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.
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.
C反应蛋白-甘油三酯-葡萄糖指数（CTI）已成为一种用于评估代谢性炎症失调的新型综合标志物，整合了胰岛素抵抗和全身炎症的标志物。然而，CTI与心血管疾病（CVD）及其死亡率之间的关联鲜有研究。本研究旨在探讨CTI与CVD死亡率、CVD发病率和全因死亡率之间的关联。
本研究纳入了2001 - 2010年、2015 - 2018年美国国家健康与营养检查调查（NHANES）中的8679名成年人。CTI的计算方法为：0.412 * Ln（CRP[mg/L]）+ Ln（TG[mg/dl]×FPG[mg/dl]）/2，参与者被分为四分位数。我们采用Kaplan-Meier曲线、Cox比例风险模型、逻辑回归分析和受限立方样条（RCS）来评估CTI在性别分层、年龄特异性和血糖亚组中与CVD死亡率、总CVD发病率和全因死亡率之间的关联。
在本研究中，CTI与CVD死亡率、总CVD发病率和全因死亡率显著正相关。CTI显著预测了CVD死亡率（风险比[HR] 2.28 [1.69 - 3.24]）和全因死亡率（HR 2.14 [1.76 - 2.55]）。此外，CTI指数与总CVD风险（比值比[OR] 2.85，95%置信区间[CI] 2.32 - 3.52）、充血性心力衰竭（OR 3.66，95% CI 2.46 - 5.35）、冠心病（OR 2.82，95% CI 1.95 - 3.97）、心绞痛（OR 2.85，95% CI 1.89 - 4.22）、心脏病发作（OR 2.59，95% CI 1.89 - 3.52）和中风（OR 2.86，95% CI 2.00 - 3.85）相关。具体而言，男性和女性之间的关联相似，年轻参与者和老年参与者之间的关联也相似。在不同的血糖状态下，发现CTI水平升高与非糖尿病（DM）个体的CVD风险增加有关。然而，在DM个体中未观察到这种关联。
我们的分析表明，CTI水平升高与CVD发病率和死亡率显著相关。CTI可能成为CVD风险的独特预测标志物。
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