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

Q: What are the key findings of this study?

Elevated C-reactive protein-triglyceride glucose index (CTI Q4 vs Q1) increased incident CVD risk by 41.5% (HR 1.415, 95% CI 1.188-1.685, P<0.001), partially mediated by blood pressure.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiovascular and cerebrovascular diseases (CVD) (n=7947). Intervention: Highest quartile of C-reactive protein-triglyceride glucose index (CTI Q4 ≥ 9.246) vs. Lowest quartile of C-reactive protein-triglyceride glucose index (CTI Q1 < 8.067). Primary outcome: Incident cardiovascular and cerebrovascular disease (composite of stroke and coronary heart disease) (HR 1.415, 95% CI 1.188-1.685, p=<0.001).

Q: What does this research mean for the field?

An elevated C-reactive protein-triglyceride glucose index independently increases the risk of incident cardiovascular and cerebrovascular disease, an association that is partially mediated by blood pressure. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the prospective association between the C-reactive protein-triglyceride glucose index and incident cardiovascular disease, and to quantify potential mediating effects of blood pressure and homocysteine.

Qingping Liu; Kang Wu; Yang Liu; Qiqi Meng; Juzhong Ke; Qian Xu; Jiaojiao Gao; Jiahui Song; Hua Qiu; Yi Zhou

doi:10.1186/s12872-026-06688-7

October 21, 2026BMC Cardiovascular DisordersOpen Access

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

View Full Paper

Ask AI

Bookmark

Share

Key result

Elevated C-reactive protein-triglyceride glucose index linked to ~42% higher incident CVD risk.

HR 1.415
95% CI 1.188-1.685
P<0.001
n=7,947

Why the study?

Discovering new risk indicators and their mechanisms is critical for preventing cardiovascular and cerebrovascular diseases, which rank first in mortality among Chinese residents. This study explored the association between the C-reactive protein-triglyceride glucose index and adult CVD risk, alongside the mediating effects of homocysteine and blood pressure.

Does a higher baseline C-reactive protein-triglyceride glucose index (CTI) increase the incidence of cardiovascular and cerebrovascular diseases in community-dwelling Chinese adults free of baseline CVD, and is this association mediated by blood pressure or homocysteine?

Key Points

To evaluate the prospective association between the C-reactive protein-triglyceride glucose index and incident cardiovascular disease, and to quantify potential mediating effects of blood pressure and homocysteine.
Recruited 7,947 cardiovascular disease-free adults from the 2019–2025 Pudong New Area chronic disease survey and followed them through June 2025 (median observation 5.53 years, 39,591.76 person-years).
Calculated baseline C-reactive protein-triglyceride glucose index from fasting C-reactive protein, triglyceride, and fasting blood glucose, categorizing participants into quartiles (Q1 to Q4).
Assessed incident cardiovascular disease, stroke, and coronary heart disease using multivariable Cox proportional hazards regression, restricted cubic splines, and bootstrap mediation analyses.
During follow-up, 1,360 cardiovascular events occurred (16.3% in Q1 vs. 31.4% in Q4); participants in Q4 had significantly higher risk than Q1 after multivariable adjustment (HR = 1.415, 95% CI: 1.188–1.685, P < 0.001).
Hypertension independently increased cardiovascular disease risk (HR = 1.830, 95% CI: 1.631–2.054, P < 0.001), whereas hyperhomocysteinemia showed no independent association (HR = 0.980, 95% CI: 0.862–1.114, P = 0.756).
Mediation analysis revealed that blood pressure partially mediated the index–cardiovascular association, with systolic blood pressure accounting for 26.39% (95% CI: 13.36%–46.27%) and diastolic blood pressure accounting for 18.25% (95% CI: 4.63%–36.58%) of the total effect.

Study Design

Type

Cohort (n=7,947)

Multicenter

Yes

Structured PICO

Does a higher baseline C-reactive protein-triglyceride glucose index (CTI) increase the incidence of cardiovascular and cerebrovascular diseases in community-dwelling Chinese adults free of baseline CVD, and is this association mediated by blood pressure or homocysteine?

P

Population

7,947 CVD-free community-dwelling Chinese adults (57.3% female) from Pudong New Area, Shanghai, followed for a median of 5.53 years.

E

Exposure

Baseline C-reactive protein-triglyceride glucose index (CTI = 0.412 × ln[CRP (mg/L)] + TyG, where TyG = ln[TG (mg/dL) × FBG (mg/dL) / 2]), stratified into four quartiles: Q1 (<8.067), Q2 (8.067 to <8.643), Q3 (8.643 to <9.246), and Q4 (≥9.246), along with blood pressure (SBP and DBP) and homocysteine (HCY) evaluated as potential mediators.

C

Comparator

Lowest quartile of C-reactive protein-triglyceride glucose index (Q1: CTI < 8.067).

O

Outcome

Composite of incident cardiovascular and cerebrovascular diseases (CVD), comprising stroke (ICD-10 I60-I64) and coronary heart disease (CHD, ICD-10 I20-I25), ascertained via active questionnaire follow-up and passive linkage with regional disease and death registries up to August 31, 2025 (median follow-up 5.53 years).composite

Main Result

Hazard Ratio: 1.415 (95% CI 1.188–1.685)

Absolute Event Rate: 21.53% vs 11.17%

p-value: p=<0.001

Limitations

Only baseline levels of blood pressure, CTI, CRP, TyG, and homocysteine were measured, lacking repeated measurements to evaluate time-varying biomarker changes.
CTI and blood pressure were collected at a single baseline cross-section, so mediation analysis reflects statistical association rather than strict causal mediation.
Study population was restricted to residents of Pudong New Area, Shanghai, limiting generalizability to other geographic regions.
CTI and blood pressure were only collected at a single baseline cross-section, so the temporal sequence between CTI (exposure) and blood pressure (mediator) cannot be confirmed.
Only baseline levels of blood pressure, CTI, CRP, TyG, and HCY were measured, lacking repeated measurements to evaluate the influence of time-varying biomarker changes on CVD risk.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

The C-reactive protein-triglyceride glucose index (CTI) is independently and linearly associated with an increased risk of incident cardiovascular and cerebrovascular diseases in Chinese adults, an effect partially mediated by elevated systolic and diastolic blood pressure rather than homocysteine.

Abstract

Cardiovascular and cerebrovascular diseases (CVD) rank first in mortality among Chinese residents. Discovering new risk indicators and their mechanisms is critical for CVD prevention. This study explored the association between the C-reactive protein-triglyceride glucose index (CTI) and adult CVD risk, as well as the mediating effect of homocysteine (HCY) and blood pressure (BP). This prospective cohort recruited 7,947 CVD-free adults from the 2019–2025 Pudong New Area chronic disease survey. Baseline detections covered C-reactive protein (CRP), triglyceride (TG), and fasting blood glucose (FBG) to calculate CTI, which was stratified into four quartiles. Participants were followed up to June 2025 to record new-onset CVD, stroke, and coronary heart disease (CHD). Cox regression evaluated CTI, HCY, and BP’s links with CVD events; restricted cubic spline (RCS) curves tested nonlinear correlations. Bootstrap analysis with 3,000 resamples was adopted for mediation effect assessment. A total of 1360 CVD events occurred during follow-up, consisting of 519 strokes and 1021 CHD cases, with CVD incidence density rising markedly with age ( P -trend < 0.05). After adjusting for age, gender, education, and other confounders, participants in the highest CTI quartile (Q4 ≥ 9.246) showed a 41.5% higher CVD risk than those in the lowest quartile (Q1 < 8.067) (HR = 1.415, 95% CI: 1.188–1.685, P < 0.001). Hypertension independently elevated CVD risk (HR = 1.830, 95%CI: 1.631–2.054, P < 0.001),while hyperhomocysteinemia(HHCY) showed no independent association with CVD risk in our analysis(HR = 0.980, 95%CI:0.862–1.114, P = 0.756). RCS models verified approximately linear associations of CTI, SBP and DBP with CVD (all P for nonlinear > 0.05). Mediation analysis revealed that BP partially mediated the relationship between CTI and CVD, with significant indirect effects through SBP (indirect effect = 0.043, 95% CI: 0.025–0.064) and DBP (indirect effect = 0.030, 95% CI: 0.008–0.052). The proportion of the total effect mediated was 26.39% (95% CI: 13.36%–46.27%) for SBP and 18.25% (95% CI: 4.63%–36.58%) for DBP, respectively. CTI and BP were independently associated with increased CVD risk, with SBP and DBP partially mediating the CTI–CVD association. HHCY showed no independent association, suggesting HCY is not a causal risk factor in this study.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Liu et al. (2026) conducted a cohort in Cardiovascular and cerebrovascular diseases (CVD) (n=7,947). Highest quartile of C-reactive protein-triglyceride glucose index (CTI Q4 ≥ 9.246) vs. Lowest quartile of C-reactive protein-triglyceride glucose index (CTI Q1 < 8.067) was evaluated on Incident cardiovascular and cerebrovascular disease (composite of stroke and coronary heart disease) (HR 1.415, 95% CI 1.188-1.685, p=<0.001). Elevated C-reactive protein-triglyceride glucose index (CTI Q4 vs Q1) increased incident CVD risk by 41.5% (HR 1.415, 95% CI 1.188-1.685, P<0.001), partially mediated by blood pressure.

synapsesocial.com/papers/6ad9e562f67b53d094565a2f https://doi.org/10.1186/s12872-026-06688-7

View Full Paper

Ask AI

Bookmark

Share

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

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading