Associations of cumulative exposure and dynamic trajectories of the C-reactive protein-triglyceride-glucose index with incident cardiovascular disease in middle-aged and older Chinese adults: a nationwide cohort study.

Objective: This study aimed to explore the relationships between cumulative C-reactive protein-triglyceride-glucose index (cuCTI) and CTI changes and the risk of new-onset cardiovascular disease (CVD) in middle-aged and older Chinese individuals.

Methods: This longitudinal study employed data from the China Health and Retirement Longitudinal Study. To evaluate the association between the cuCTI index and CVD risk, we conducted Cox regression analyses alongside restricted cubic spline (RCS) regression models. The participants were categorized into three groups on the basis of the dynamic changes in the CTI through K-means clustering. Subgroup analysis and sensitivity analysis were performed to confirm the robustness of the results.

Results: A total of 4157 participants were included in the study, of whom 609 (13.5%) were diagnosed with CVD. The incidence risk of CVD increased with increasing cuCTI. In fully adjusted Model 3, the Cox regression results indicated that, compared with those in Q1, participants in Q2 had a significantly greater risk of developing CVD (HR, 1.53 [1.22, 1.92], P < 0.001); similarly, participants in Q3 had a 1.36 [1.07, 1.74] increased risk (P = 0.014). RCS analysis revealed a linear association between cuCTI and the risk of CVD (P < 0.05). K-means clustering identified three groups of CTI trajectory changes. Compared with participants with consistently low CTI levels, those with persistently high and increasing CTI levels had a significantly elevated risk of developing CVD (HR, 1.31 [95% CI 1.01-1.70], P = 0.041). Subgroup and interaction analyses revealed no statistically significant differences across all subgroups (all p > 0.05).

Conclusion: This study revealed that cuCTI and changes in CTI are independently associated with the risk of CVD among middle-aged and elderly individuals with elevated cuCTI levels, particularly those with sustained high CTI levels, exhibited a significantly higher risk of CVD. As a cost-effective and accessible tool, cuCTI may provide supplementary information for assessing CVD risk. Monitoring long-term changes in the CTI and maintaining it at relatively low levels may aid early identification of individuals at high risk for CVD.