Association of C-reactive protein-triglyceride glucose index and its modified indices with stroke risk in individuals at cardiovascular-kidney-metabolic syndrome stages 0–3: a population-based cohort study
Authors' conclusion
CTI and adiposity-modified CTI indices were independently associated with incident stroke among adults at CKM stages 0-3, especially in advanced CKM stages.
Study context
- Population
- Adults aged ≥45 at Cardiovascular-Kidney-Metabolic (CKM) stages 0–3, China Health and Retirement Longitudinal Study (CHARLS)
- Participants
- 3,348 adults
- Exposure
- Highest vs lower tertiles of CTI and adiposity-modified CTI indices
- Outcome
- Incident stroke
Methodological detailsChina Health and Retirement Longitudinal Study (CHARLS)
- China Health and Retirement Longitudinal Study (CHARLS)
Main finding
As reported in the abstract
Stroke risk, highest tertile of CTI-related indices (fully adjusted)
Hazard ratio (95% CI)
Original CTI highest tertile
1.92(1.35–2.73)
CTI-WHtR highest tertile
2.52(1.76–3.61)
- Incident stroke cases during follow-up
- 263 (7.9%)
Observational data: associations, not effects.
Further findings
| Outcome | IDI (95% CI) | P value |
|---|---|---|
| Prediction (fixed-horizon ROC) · 3 yearsCTI-BMI vs CTI | 0.0021 (0.0004–0.0038) | P = 0.012 |
- Prediction (fixed-horizon ROC) — 3-year AUCs for all indices exceeded
- 0.70
Trajectories of CTI and modified indices
- Vs stable group, markedly and slowly increasing trajectories significantly associated with higher stroke risk
Prediction (fixed-horizon ROC) · 3 years
- CTI-BRI, CTI-BMI, CTI-WC, CTI-WHtR significantly higher AUCs than original CTI; cumCTI-BMI and cumCTI-WHtR higher 3-year AUCs than cumCTI
CKM stage subgroups
- Associations stronger in advanced CKM stages (2-3)
Component contribution (weighted quantile sum (WQS))
- CVAI primary driver, 2012
- 29.0%
- CVAI primary driver, 2015
- 29.3%
Mediation by estimated pulse wave velocity (ePWV)
- Mediation proportions
- 12.44%-21.20%
Original publication
Association of C-reactive protein-triglyceride glucose index and its modified indices with stroke risk in individuals at cardiovascular-kidney-metabolic syndrome stages 0–3: a population-based cohort study. Cardiovasc Diabetol. Published 7 July 2026. doi:10.
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