Evidence mapPaperPMID 41937151Full record

ArticleCardiovascular diabetology2026

Associations between the C-reactive protein-triglyceride glucose index and the incidence and progression trajectory of cardiometabolic multimorbidity: a multi-state model study.

Lei Yuan, Zhe Zhao, Hongxiang Peng, Wen Zong, Juanfang Zhu, Huilong Qu, Chun Liang, Jan Nilsson, Yihong Chen

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Article in Cardiovascular diabetology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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5 · Who and what money

Authors and funding

9 authors.

Lei YuanFaculty of Military Health Service, Naval Medical University, Shanghai, China.
Zhe ZhaoFaculty of Military Health Service, Naval Medical University, Shanghai, China.
Hongxiang PengOffice of Academic Affairs, Naval Medical University, Shanghai, China.
Wen ZongFaculty of Military Health Service, Naval Medical University, Shanghai, China.
Juanfang ZhuFaculty of Military Health Service, Naval Medical University, Shanghai, China.
Huilong QuDepartment of Cardiology, Second Affiliated Hospital of Naval Medical University, Shanghai, China.
Chun LiangDepartment of Cardiology, Second Affiliated Hospital of Naval Medical University, Shanghai, China.
Jan NilssonDepartment of Clinical Sciences Malmö, Lund University, Malmö, 20502, Sweden. jan.nilsson@med.lu.se.
Yihong ChenDepartment of Cardiology, Second Affiliated Hospital of Naval Medical University, Shanghai, China. yihong.chen@med.lu.se.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe C-reactive protein-triglyceride-glucose index (CTI) has been proposed as a novel biomarker for insulin resistance and inflammation. However, its role in the progression trajectory of cardiometabolic multimorbidity (CMM) remains unclear. We aimed to investigate the involvement of the CTI in the CMM progression trajectory.

methodsThis prospective study included 266,049 individuals from the UK Biobank, who were free of cardiometabolic diseases (CMD) at baseline. CMM was defined as the presence of two or more CMDs, including type 2 diabetes (T2D), coronary heart disease (CHD), and stroke. The CTI was calculated using the formula: 0.412 × ln (CPR) + ln (TG×FPG/2). Cox proportional hazards, Kaplan–Meier curves, restricted cubic spline (RCS) and multi-state models were employed to examine associations of CTI with the incidence and progression of CMM. Receiver operating characteristic (ROC) curve, C-index analysis, net reclassification index (NRI) together with integrated discrimination improvement index (IDI) were carried out to examinate the predictive performance of CTI. The robustness of results was further evaluated via stratified and sensitivity analyses.

resultsCTI was positively and significantly associated with CMM development. Compared with the low-CTI group, the high-CTI group exhibited an increased risks of T2D (HR: 3.60, 95% CI 3.39–3.83), stroke (HR: 1.11, 95% CI 1.03–1.19), CHD (HR: 1.52, 95% CI 1.46–1.58), first cardiometabolic disease (FCMD, HR: 1.86, 95% CI 1.81–1.92), CMM (HR: 2.50, 95% CI 2.23–2.80), and death (HR: 1.25, 95% CI 1.20–1.29). Among CMM and its component diseases, CTI showed the greater predictive capacity for T2D and CMM risk. Additionally, CTI exhibited incremental predictive value over TyG and CRP for incident CHD, FCMD and CMM with the highest C-index and NRI values. Stratified analyses indicated the consistent association of CTI with all outcomes except for stroke across age, gender and BMI. Specifically, stronger associations were observed in younger, female and lower BMI individuals. In state transition analysis, the high-CTI group showed elevated risks for transitions from baseline to FCMD (HR: 1.86, 95% CI 1.80–1.91), baseline to death (HR: 1.18, 95% CI 1.12–1.23), and FCMD to CMM (HR: 1.39, 95% CI 1.24–1.56). In disease-specific transitions, a higher CTI was linked to increased risks of transitions from baseline to T2D (HR: 3.68, 95% CI 3.45–3.93), baseline to CHD (HR: 1.49, 95% CI 1.43–1.56), baseline to death (HR: 1.18, 95% CI 1.12–1.23), stroke to CMM (HR: 1.43, 95% CI 1.09–1.86), and CHD to CMM (HR: 1.52, 95% CI 1.29–1.79). Similar findings were observed when the CTI was treated as a continuous variable.

conclusionOur data revealed that CTI was positively correlated with the incidence and progression trajectory of CMM. CTI could serve as a simple and scalable tool for risk stratification in CMM, highlighting its potential utility in screening population with cardiometabolic-inflammatory burden.

Indexed as

Blood GlucoseCoronary DiseaseC-Reactive ProteinDiabetes Mellitus, Type 2StrokeTriglyceridesAgedBiomarkersCardiometabolic Risk FactorsDisease ProgressionFemaleHumansIncidenceMaleMiddle AgedMultimorbidityBiomarkersBlood GlucoseC-Reactive ProteinTriglyceridesCardiometabolic multimorbidityCoronary heart diseasesC-reactive protein-triglyceride glucose indexStrokeType 2 diabetes

Identifiers

PMID41937151
PMCPMC13085370

What Socratic holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.