The C-reactive protein–triglyceride glucose index (CTI) has been associated with stroke risk in prior studies. However, its relevance among individuals with cardiovascular-kidney-metabolic (CKM) syndrome remains uncertain. This study included 5767 participants with CKM syndrome stages 0–3 from the China Health and Retirement Longitudinal Study. CTI was calculated as: CTI = 0.412 × lnhs-CRP (mg/L) + ln(triglyceride (mg/dL) × fasting glucose (mg/dL)) / 2. The primary outcome was incident stroke, assessed via self-reported questionnaires, with follow-up spanning 2011 to 2020. Cox proportional hazards models, restricted cubic spline (RCS) analysis, and subgroup analyses were used to examine the association between CTI and stroke risk. Time-dependent receiver operating characteristic (ROC) curve analysis was performed to compare the predictive performance of CTI with the triglyceride–glucose index (TyG) and the metabolic score for insulin resistance. Multiple testing correction was performed using the false discovery rate approach. After adjustment for potential confounders, higher CTI levels were significantly associated with increased stroke risk (HR 1.33, 95% CI 1.18–1.51). RCS analysis indicated a linear association, with no evidence of nonlinearity (P for nonlinearity = 0.182). Subgroup analyses indicated that elevated CTI was significantly associated with higher stroke risk in individuals at CKM stages 2 (HR 1.27, 95% CI 1.04–1.56; P = 0.019, adjusted P = 0.023) and 3 (HR 1.25, 95% CI 1.04–1.50; P = 0.022, adjusted P = 0.025), but no significant association was observed at stages 0–1. ROC analysis revealed that CTI consistently outperformed TyG in predicting stroke at years 5 and 7, as confirmed by DeLong's test (adjusted P = 0.028 for both). CTI is positively and linearly associated with stroke risk in individuals with CKM syndrome, particularly in stages 2 and 3. Furthermore, CTI provides superior predictive accuracy compared to TyG.
Xu et al. (Tue,) studied this question.