C-reactive protein–triglyceride glucose index for the detection of the severity of coronary artery disease in different glucose metabolic states in patients with H-type hypertension

Abstract

Abstract Background The C-reactive protein–triglyceride glucose index (CTI) is a novel composite biomarker that integrates inflammation and insulin resistance. However, its association with the severity of coronary artery disease (CAD) in patients with H-type hypertension under different glucose metabolism statuses remains unclear. Methods This retrospective study enrolled 1392 hypertensive patients who underwent coronary angiography. CTI was calculated as 0.412 × ln(CRP[mg/L]) + ln(TG[mg/dL] × FPG [mg/dL]/2). Patients were divided into three groups according to CTI tertiles: T1 group (6.748 ≤ CTI < 8.674), T2 group (8.674 ≤ CTI < 9.549), and T3 group (9.549 ≤ CTI ≤ 12.713). Based on the Gensini score derived from coronary angiography, the study cohort was divided into three groups according to the severity of stenosis: low stenosis, medium stenosis, and high stenosis. Logistic regression, restricted cubic spline (RCS) analysis, and receiver operating characteristic (ROC) curve analysis were used to investigate the association between CTI and CAD severity across different glucose metabolism statuses and H‑type hypertension subgroups. Incremental utility of CTI was evaluated using receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA). Results The results show that CTI is significantly associated with CAD severity in hypertensive patients. After adjusting for risk factors, CTI remained significantly associated with multi-vessel CAD (OR = 2.155, 95%CI 1.839–2.455) and moderate-to-severe coronary stenosis (OR = 1.818, 95% CI 1.603–2.062). RCS analysis revealed a linear dose–response relationship between CTI and CAD severity (P for non-linearity > 0.05). Notably, we observed significant interaction between CTI and H-type hypertension on CAD severity ( P = 0.033). Under different glycemic statuses, high CTI levels were associated with CAD severity; however, no association between CTI and moderate‑to‑severe coronary stenosis was observed in patients with diabetes mellitus (DM). In the DM subgroup of patients with H-type hypertension, after adjustment for risk factors, patients in the T3 group had a 6.475-fold increased risk of multi-vessel CAD compared with those in the T1 group (95% CI 1.693–24.773, P = 0.006). ROC analysis demonstrated that, across different glucose metabolism subgroups, CTI showed the highest discriminative ability for multi‑vessel CAD in patients with H‑type hypertension and comorbid DM (AUC = 0.712, 95% CI 0.619–0.804, P < 0.001). Conclusion CTI is an independently associated factor for coronary stenosis severity in patients with hypertension, particularly in those with H‑type hypertension and comorbid diabetes. This simple and cost‑effective composite biomarker holds promise as a practical tool for early risk stratification and for guiding individualized prevention strategies.