Association between C-reactive protein-triglyceride-glucose index and the risk of cardiovascular-kidney metabolic syndrome progression:The Kailuan Study

Background The American Heart Association (AHA) has proposed the concept of cardiovascular-kidney-metabolic (CKM) syndrome to describe the interrelationships between heart, kidney, and metabolic diseases. Advanced cardiovascular-kidney-metabolic (CKM) syndrome has profound impacts on adverse clinical outcomes, particularly cardiovascular disease (CVD). C-reactive protein-triglyceride-glucose index (CTI) has emerged as a potential risk factor for metabolic and cardiovascular disorders, but its association with CKM syndrome remains unexplored. Methods This study included 96,212 participants with CKM syndrome stages 0–4 from the Kailuan Study. All participants were monitored biennially until 31 December 2022. During follow-up, 14,223 participants were diagnosed as having CVD. Regression models were conducted to estimate the association between CTI and advanced CKM stages at baseline. Cox regression models were employed to assess the association between baseline CTI and incident CVD during follow-up. Results At baseline, participants in the higher CTI quartiles (Q2–Q4) exhibited a significantly elevated risk of being in advanced CKM stages relative to those in the lowest quartile (Q1) (P < 0.001). Over a median follow-up of 12.1 years, 14,223 cases of incident CVD (16.59%) were identified among individuals initially at CKM stages 0–3. After multivariable adjustment, each 1-standard deviation increase in CTI was independently associated with an increased CVD risk. When analyzed by quartiles, the Q3 [hazard ratio (HR) = 1.227, 95% CI: 1.164–1.293] and Q4 (HR = 1.266, 95% CI: 1.198–1.337) groups continued to show significantly higher risks of CVD compared to the first quartile reference group. Conclusions Elevated CTI was independently correlated with more advanced CKM syndrome stages. Moreover, in participants with CKM syndrome and no pre-existing cardiovascular disease, higher CTI levels significantly predicted an increased incidence of CVD events. These findings suggest that targeted assessment and intervention addressing CTI could help mitigate CKM progression and reduce cardiovascular risk, and its predictive value is significantly superior to that of the TyG index and hs-CRP.