What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Coronary heart disease (n=19451). Intervention: C-reactive protein-triglyceride glucose index (CTI) vs. Lower CTI levels. Primary outcome: Prevalent coronary heart disease (OR 1.357, 95% CI 1.147-1.604, p=0.001).

October 15, 2024Open Access

Usefulness of C-reactive protein-triglyceride glucose index in detecting prevalent coronary heart disease: findings from the National Health and Nutrition Examination Survey 1999–2018

Key Result

Each standard deviation increase in the C-reactive protein-triglyceride glucose index was associated with a 1.357 times higher odds of prevalent coronary heart disease.

Study Design

Type

Cross-Sectional (n=19,451)

Multicenter

Yes

Structured PICO

Does a higher C-reactive protein-triglyceride glucose index (CTI) associate with prevalent coronary heart disease in the general American population?

Population

19,451 subjects aged 20 to 85 years from the general American population (National Health and Nutrition Examination Survey 1999-2010), mean age 45.79, 48.68% male.

Intervention

Higher C-reactive protein-triglyceride glucose index (CTI) evaluated as a continuous variable and in quartiles

Comparator

Lower C-reactive protein-triglyceride glucose index (CTI) (bottom quartile or continuous comparison)

Outcome

Prevalent coronary heart disease (CHD) ascertained according to questionnaire

The C-reactive protein-triglyceride glucose index (CTI) is positively and linearly associated with prevalent coronary heart disease and may modestly improve risk stratification when added to the Framingham risk score.

Main Result

Effect estimate: OR 1.357 (95% CI 1.147-1.604)

p-value: p=0.001

Limitations

Cross-sectional design precludes the determination of causal relationships between CTI and CHD
Exclusion of participants lacking relevant variables may introduce selection bias
Reliance on self-reported information raises concerns about recall limitations and subjectivity
Conducted exclusively in the United States, limiting generalizability to other populations
Marginal increase in AUC value for detecting prevalent CHD
Potential influence of unmeasured confounders cannot be ruled out

Abstract

Background: Coronary heart disease (CHD) is one of the leading causes of mortality. The current study aims to assess the association between C-reactive protein-triglyceride glucose index (CTI) and the risk of prevalent CHD and to evaluate the usefulness of CTI to refine the identification of prevalent CHD. Methods: 19,451 subjects from the National Health and Nutrition Examination Survey 1999-2010 were enrolled. CHD was ascertained according to the questionnaire. Results: The prevalent of CHD was 6.23%. After adjusting for conventional cardiovascular risk factors, each SD increase of CTI could cast a 1.357 times risk of CHD. In quartile analysis, the top quartile had a 1.807 times risk of CHD than the bottom quartile. Smooth curving fitting displayed that the association was linear in the entire range of CTI. Subgroup analysis revealed that the association was robust among several common subpopulations but stronger in subjects aged <60. Finally, both ROC and reclassification analysis demonstrated a significant improvement in identifying CHD when introducing CTI to the Framingham risk score. Conclusion: CTI has a positive, linear, and robust association with prevalent CHD in the general American population, and CTI may help to improve the detection of prevalent CHD in the general population.

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