Associations between the C-reactive protein-triglyceride glucose index and the incidence and progression trajectory of cardiometabolic multimorbidity: a multi-state model study
Authors' conclusion
Our data revealed that CTI was positively correlated with the incidence and progression trajectory of CMM.
Study context
- Population
- UK Biobank participants free of cardiometabolic diseases at baseline; Cardiometabolic multimorbidity (CMM) = ≥2 of T2D, coronary heart disease (CHD) and stroke
- Participants
- 266,049 participants
- Exposure
- High CTI vs low CTI
- Outcome
- Incidence and progression trajectory of cardiometabolic multimorbidity (CMM)
Methodological detailsUK Biobank, multi-state model
- UK Biobank
- Multi-state model
Main finding
As reported in the abstract
Incident outcomes, high vs low CTI
Each group vs Low-CTIEstimate (95% CI)
High-CTI
HR (T2D) 3.60(3.39–3.83)
High-CTI
HR (stroke) 1.11(1.03–1.19)
High-CTI
HR (CHD) 1.52(1.46–1.58)
High-CTI
HR (first cardiometabolic disease) 1.86(1.81–1.92)
High-CTI
HR (CMM) 2.50(2.23–2.80)
High-CTI
HR (death) 1.25(1.20–1.29)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| State transitions (multi-state model)High-CTIvs Low-CTIBaseline to FCMD | 1.86 (1.80–1.91) | |
| State transitions (multi-state model)High-CTIvs Low-CTIBaseline to death | 1.18 (1.12–1.23) | |
| State transitions (multi-state model)High-CTIvs Low-CTIFCMD to CMM | 1.39 (1.24–1.56) | |
| 0.512Hazard ratio (log scale) |
Disease-specific transitions with higher CTI
- Higher CTI, baseline to T2D: HR
- 3.68 (3.45-3.93) (95% CI)
- Higher CTI, baseline to CHD: HR
- 1.49 (1.43-1.56) (95% CI)
- Higher CTI, baseline to death: HR
- 1.18 (1.12-1.23) (95% CI)
- Higher CTI, stroke to CMM: HR
- 1.43 (1.09-1.86) (95% CI)
- Higher CTI, CHD to CMM: HR
- 1.52 (1.29-1.79) (95% CI)
Predictive performance
- CTI showed greater predictive capacity for T2D and CMM risk among CMM and its component diseases
- CTI had incremental predictive value over TyG and CRP for incident CHD, first cardiometabolic disease (FCMD) and CMM, with the highest C-index and net reclassification index (NRI) values
Stratified analyses by age, gender and BMI
- Consistent association of CTI with all outcomes except stroke; stronger in younger, female and lower-BMI individuals
CTI as a continuous variable
- Similar findings with CTI as a continuous variable
Original publication
Associations between the C-reactive protein-triglyceride glucose index and the incidence and progression trajectory of cardiometabolic multimorbidity: a multi-state model study. Cardiovasc Diabetol. Published 5 April 2026. doi:10.
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