Frontiers in immunology · 2026
Association between the C-reactive protein-triglyceride-glucose index and incident cardiovascular disease in middle-aged and older adults with arthritis: a nationwide prospective cohort study with hospital-based cross-sectional replication.
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Luo Feng, Guo Jia-Jie, Xu Ting, Yuan Xue-Mei, Gao Jia-Kun, Zhang Xi-Cheng, Peng Chen, Wang Qiu-Yi, Ling Yi, Yao Xue-Ming, Ma Wu-Kai
Аннотация
BACKGROUND: Arthritis encompasses heterogeneous joint and rheumatic conditions and is associated with increased cardiovascular disease (CVD) risk. The C-reactive protein-triglyceride-glucose index (CTI) integrates inflammatory and metabolic burden, but its association with CVD among adults with arthritis remains unclear.
METHODS: Data from the China Health and Retirement Longitudinal Study (CHARLS) and an independent hospital-based cross-sectional replication cohort were analyzed. In the CHARLS, baseline CTI was assessed in 2,894 adults with self-reported physician-diagnosed arthritis or rheumatism. Cumulative CTI exposure (cumCTI) and exploratory two-time-point CTI level-change patterns were evaluated in 1,394 participants using Wave 3 in 2015 as the time origin. Cox regression, restricted cubic spline, subgroup, sensitivity, and exploratory predictive performance analyses were performed for incident CVD. In the hospital-based cohort, 7,960 participants were analyzed using logistic regression and spline analyses for prevalent CVD.
RESULTS: In the CHARLS, 771 incident CVD events occurred in the baseline CTI analysis, and 300 occurred in the repeated-measures analyses. In fully adjusted models, baseline CTI was associated with incident CVD [hazard ratio (HR) = 1.251, 95% confidence interval (CI): 1.083-1.446, p = 0.002], with the highest risk in Q4 versus Q1 (HR = 1.587, 95% CI: 1.257-2.003; p for trend < 0.001). cumCTI was also associated with incident CVD (HR = 1.118, 95% CI: 1.025-1.220, p = 0.012), with higher risk in Q4 versus Q1 (HR = 1.504, 95% CI: 1.038-2.179; p for trend = 0.012). Compared with Cluster 1, both Cluster 2 and Cluster 3 were associated with higher CVD risk. In the hospital-based cross-sectional replication cohort, baseline CTI was associated with prevalent CVD recorded in hospital medical records. Exploratory predictive analyses showed modest discrimination for CTI [area under the curve (AUC) = 0.556, 95% CI: 0.529-0.583], and adding CTI to the basic model changed Harrell's C-index from 0.615 to 0.618.
CONCLUSION: Higher CTI-related inflammatory-metabolic burden was associated with increased CVD risk in middle-aged and older adults with arthritis. CTI may provide complementary information for recognizing inflammatory-metabolic cardiovascular vulnerability in adults with arthritis, but its incremental predictive value was modest and requires further validation.
METHODS: Data from the China Health and Retirement Longitudinal Study (CHARLS) and an independent hospital-based cross-sectional replication cohort were analyzed. In the CHARLS, baseline CTI was assessed in 2,894 adults with self-reported physician-diagnosed arthritis or rheumatism. Cumulative CTI exposure (cumCTI) and exploratory two-time-point CTI level-change patterns were evaluated in 1,394 participants using Wave 3 in 2015 as the time origin. Cox regression, restricted cubic spline, subgroup, sensitivity, and exploratory predictive performance analyses were performed for incident CVD. In the hospital-based cohort, 7,960 participants were analyzed using logistic regression and spline analyses for prevalent CVD.
RESULTS: In the CHARLS, 771 incident CVD events occurred in the baseline CTI analysis, and 300 occurred in the repeated-measures analyses. In fully adjusted models, baseline CTI was associated with incident CVD [hazard ratio (HR) = 1.251, 95% confidence interval (CI): 1.083-1.446, p = 0.002], with the highest risk in Q4 versus Q1 (HR = 1.587, 95% CI: 1.257-2.003; p for trend < 0.001). cumCTI was also associated with incident CVD (HR = 1.118, 95% CI: 1.025-1.220, p = 0.012), with higher risk in Q4 versus Q1 (HR = 1.504, 95% CI: 1.038-2.179; p for trend = 0.012). Compared with Cluster 1, both Cluster 2 and Cluster 3 were associated with higher CVD risk. In the hospital-based cross-sectional replication cohort, baseline CTI was associated with prevalent CVD recorded in hospital medical records. Exploratory predictive analyses showed modest discrimination for CTI [area under the curve (AUC) = 0.556, 95% CI: 0.529-0.583], and adding CTI to the basic model changed Harrell's C-index from 0.615 to 0.618.
CONCLUSION: Higher CTI-related inflammatory-metabolic burden was associated with increased CVD risk in middle-aged and older adults with arthritis. CTI may provide complementary information for recognizing inflammatory-metabolic cardiovascular vulnerability in adults with arthritis, but its incremental predictive value was modest and requires further validation.