Associations of cumulative exposure and change pattern of the C-reactive protein-triglyceride-glucose index with stroke risk in a population with cardiovascular-kidney-metabolic syndrome stages 0–3: a longitudinal analysis based on CHARLS

Abstract

The C-reactive protein–triglyceride-glucose index (CTI) has shown potential in cardiometabolic risk assessment. However, evidence regarding cumulative CTI (cuCTI) exposure, longitudinal CTI change pattern, and incident stroke in individuals with cardiovascular-kidney-metabolic (CKM) syndrome remains limited. We aimed to investigate the associations of cuCTI exposure and CTI change-pattern clusters with new-onset stroke in individuals with CKM syndrome stages 0–3. This longitudinal study included 4,934 participants with CKM syndrome stages 0–3 from the China Health and Retirement Longitudinal Study. cuCTI was derived from repeated CTI measurements in 2012 and 2015. Incident stroke was defined by self-reported physician diagnosis during follow-up. Cox proportional hazards models, restricted cubic spline analyses, and K-means clustering were used to evaluate the associations of cuCTI and CTI change pattern with stroke risk. During a median follow-up of 5 years, 346 participants developed stroke (7.0%). Stroke risk increased across higher cuCTI levels. In the fully adjusted model, participants in the highest cuCTI quartile had a significantly higher risk of stroke than those in the lowest quartile (HR 2.162, 95% CI 1.504–3.108; P<0.001). Restricted cubic spline analysis showed a positive linear association between cuCTI and stroke risk. Three CTI change-pattern clusters were identified, and both moderate-increasing and high-stable clusters were associated with higher stroke risk than the low-stable. Higher cuCTI exposure and adverse CTI change patterns were independently associated with incident stroke in individuals with CKM syndrome stages 0–3. Monitoring long-term changes in CTI may help identify individuals with a greater metabolic-inflammatory burden and inform future stroke prevention strategies. Not applicable.