Abstract
Cardiovascular-Kidney-Metabolic (CKM) syndrome, a concept recently introduced by the American Heart Association (AHA), emphasizes the intricate relationships among metabolic, renal, and cardiovascular diseases. The C-reactive protein-triglyceride-glucose index (CTI) has been proposed as an effective biomarker for insulin resistance (IR) and inflammation. Although there is substantial evidence demonstrating an association between the CTI and cardiovascular disease (CVD), its precise role in individuals with CKM syndrome stage 0-3 remains unclear. This prospective cohort study analysed data from China Health and Retirement Longitudinal Study (CHARLS), with a follow-up period of 10 years. The exposure variable was CTI at baseline, which was calculated as a combination of triglyceride (TG), fasting blood glucose (FBG), and C-reactive protein (CRP). The primary endpoint was the CVD. Cox proportional hazards regression and restricted cubic spline (RCS) analysis were conducted to examine the association between CTI and CVD risk. This study included 7,711 participants (52.38% female; mean age, 59.01 ± 9.37 years). An elevated CTI was significantly associated with a greater risk of developing CVD. Specifically, after fully adjusting for potential confounders, each one-unit increase in the CTI was associated with a 16% increase in CVD risk (hazard ratio [HR] = 1.16; 95% confidence interval [CI]: 1.06-1.27). Compared with participants in the lowest CTI group, those in the highest CTI group had a 42% greater CVD risk (HR = 1.42; 95% CI: 1.20-1.68). RCS analysis revealed a nonlinear association between CTI and the CVD risk among individuals with CKM syndrome stage 0-3 (overall P < 0.001; nonlinearity P = 0.01). This study revealed a positive association between CTI and CVD risk among individuals with CKM syndrome stages 0-3, suggesting that CTI may serve as a practical tool for CVD risk stratification in this population.