C-reactive protein-triglyceride-glucose index and its obesity-related derivatives as predictors of cardiovascular incidence and cause-specific mortality among cancer survivors: a prospective cohort study

Background The C-reactive protein–triglyceride glucose index (CTI), an innovative composite marker for evaluating metabolic-inflammatory dysregulation, remains unclear in its clinical utility among cancer survivors. This study aims to evaluate the associations of CTI and its obesity-related derivatives with cardiovascular disease (CVD) risk, stroke events, heart failure events, all-cause mortality, and CVD-related mortality in cancer survivors. Methods This prospective cohort study was conducted using data from the UK Biobank. Participants were categorized according to quartiles of CTI-related indices. Univariate and multivariate Cox regression models, along with restricted cubic splines (RCS), were used to evaluate the associations between CTI-related indices and all five study endpoints. Predictive performance was assessed using receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Sensitivity and subgroup analyses were performed to evaluate the robustness of the findings. Results Among cancer survivors, high CTI-related indices were significantly and positively associated with incident CVD events (HR 1.65 [1.44–1.89]), heart failure events (HR 2.28 [1.81–2.87]), all-cause mortality (HR 1.54 [1.38–1.71]), and CVD-related mortality (HR 3.71 [1.77–7.79]). Adding CTI-related indices, particularly CTI-WHtR, to a basic demographic model significantly improved the prediction of these outcomes. Notably, the association between CTI-WHtR and all-cause mortality was more pronounced in participants aged < 60 years, females, never-smokers, and those without hypertension. Moreover, no evident association was observed between CTI-WHtR and cardiovascular-disease-specific mortality among participants receiving oral anticoagulant therapy. Conclusion Elevated CTI-related indices were significantly associated with a higher risk of cardiovascular events. CTI-WHtR may serve as a simple accessible marker for stratifying the future risk of CVD events in cancer survivors.