The C-reactive protein-triglyceride-glucose index (CTI), a composite marker of systemic inflammation and insulin resistance, may help identify early cardiovascular risk. A longitudinal analysis from the Coronary Artery Risk Development in Young Adults (CARDIA) study published in Clinical Cardiology evaluated whether CTI was associated with coronary artery calcium (CAC) progression.

Participants with CAC measurements at years 15, 20, and 25 were included. CTI was calculated from fasting blood samples obtained at year 15 and categorized into quartiles. CAC was measured using standardized computed tomography.

CAC progression was defined as incident CAC >0 in participants with baseline CAC = 0, an annualized CAC increase of at least 10 units for baseline CAC 0 to 100, or an annualized increase of at least 10% for baseline CAC ≥100. Cox proportional hazards models adjusted for cardiovascular risk factors were used to estimate hazard ratios (HRs).

The study included 2,655 participants with a mean age of 40.3 ± 3.6 years, and 44.7% were men. Over a mean follow-up of 8.9 ± 2.0 years, CAC progression occurred in 704 individuals (26.5%). After adjustment, participants in the highest CTI quartile had a higher risk of CAC progression than those in the lowest quartile (HR 1.38, 95% CI 1.072 to 1.775).

Associations were consistent across subgroups defined by age, sex, race, body mass index, and baseline CAC status, and remained robust after excluding participants with baseline diabetes or lipid-lowering therapy use. These findings suggest CTI may help identify individuals at elevated risk of subclinical atherosclerosis.