Joint Associations of Cumulative C-Reactive Protein–Triglyceride–Glucose Index and Depression with Cardiovascular Outcomes in Middle-Aged and Older Adults: A National Prospective Cohort Study

Qinxian Tu; Zhuoxuan He; Yizhuo Duan; Xiongjing Jiang; Hui Dong; Yubao Zou

doi:10.5334/gh.1565

Joint Associations of Cumulative C-Reactive Protein–Triglyceride–Glucose Index and Depression with Cardiovascular Outcomes in Middle-Aged and Older Adults: A National Prospective Cohort Study

Global Heart

Volume 21 (2026): Issue 1

By: Qinxian Tu, Zhuoxuan He, Yizhuo Duan, Xiongjing Jiang, Hui Dong and Yubao Zou

Open Access

|Jun 2026

Prugger C, Perier MC, Gonzalez-Izquierdo A, Hemingway H, Denaxas S, Empana JP. Incidence of 12 common cardiovascular diseases and subsequent mortality risk in the general population. Eur J Prev Cardiol. 2023;30(15):1715–1722. DOI: 10.1093/eurjpc/zwad192
Open DOI Search in Google Scholar Back to article
Lindstrom M, DeCleene N, Dorsey H, Fuster V, Johnson CO, LeGrand KE, et al. Global Burden of Cardiovascular Diseases and Risks Collaboration, 1990–2021. J Am Coll Cardiol. 2022;80(25):2372–2425. DOI: 10.1016/j.jacc.2022.11.001
Open DOI Search in Google Scholar Back to article
Wang X, Ma H, Li X, Heianza Y, Manson JE, Franco OH, et al. Association of Cardiovascular Health With Life Expectancy Free of Cardiovascular Disease, Diabetes, Cancer, and Dementia in UK Adults. JAMA Internal Medicine. 2023;183(4):340–349. DOI: 10.1001/jamainternmed.2023.0015
Open DOI Search in Google Scholar Back to article
Park DY, Jamil Y, Babapour G, Kim J, Campbell G, Akman Z, et al. Association of cardiovascular diseases with cognitive performance in older adults. Am Heart J. 2024;273:10–20. DOI: 10.1016/j.ahj.2024.03.016
Open DOI Search in Google Scholar Back to article
GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022;9(2):137–150. DOI: 10.1016/s2215-0366(21)00395-3
Open DOI Search in Google Scholar Back to article
Hage Z, Madeira MM, Koliatsis D, Tsirka SE. Convergence of endothelial dysfunction, inflammation and glucocorticoid resistance in depression-related cardiovascular diseases. BMC Immunol. 2024;25(1):61. DOI: 10.1186/s12865-024-00653-9
Open DOI Search in Google Scholar Back to article
Penninx BW. Depression and cardiovascular disease: Epidemiological evidence on their linking mechanisms. Neurosci Biobehav Rev. 2017;74(Pt B):277–286. DOI: 10.1016/j.neubiorev.2016.07.003
Open DOI Search in Google Scholar Back to article
Pinter A, Szatmari S Jr., Horvath T, Penzlin AI, Barlinn K, Siepmann M, et al. Cardiac dysautonomia in depression – heart rate variability biofeedback as a potential add-on therapy. Neuropsychiatr Dis Treat. 2019;15:1287–1310. DOI: 10.2147/ndt.S200360
Open DOI Search in Google Scholar Back to article
Harshfield EL, Pennells L, Schwartz JE, Willeit P, Kaptoge S, Bell S, et al. Association Between Depressive Symptoms and Incident Cardiovascular Diseases. JAMA. 2020;324(23):2396–2405. DOI: 10.1001/jama.2020.23068
Open DOI Search in Google Scholar Back to article
Krittanawong C, et al. Association of Depression and Cardiovascular Disease. The American Journal of Medicine. 2023;136(9):881–895. DOI: 10.1016/j.amjmed.2023.04.036
Open DOI Search in Google Scholar Back to article
Carney RM, Freedland KE, Rich MW. Treating Depression to Improve Survival in Coronary Heart Disease: What Have We Learned? JACC. 2024;84(5):482–489. DOI: 10.1016/j.jacc.2024.05.038
Open DOI Search in Google Scholar Back to article
Pan Y, Chen Y, Wu S, Ying P, Zhang Z, Tan X, et al. Prevalence and management of depressive symptoms in coronary heart disease patients and relationship with cardiovascular prognosis: a prospective cohort study. BMC Psychiatry. 2024;24(1):644. DOI: 10.1186/s12888-024-06117-z
Open DOI Search in Google Scholar Back to article
Wu Q, Kling JM. Depression and the Risk of Myocardial Infarction and Coronary Death: A Meta-Analysis of Prospective Cohort Studies. Medicine. 2016;95(6):e2815. DOI: 10.1097/md.0000000000002815
Open DOI Search in Google Scholar Back to article
Dong JY, Zhang YH, Tong J, Qin LQ. Depression and risk of stroke: a meta-analysis of prospective studies. Stroke. 2012;43(1):32–37. DOI: 10.1161/strokeaha.111.630871
Open DOI Search in Google Scholar Back to article
Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 2008;6(4):299–304. DOI: 10.1089/met.2008.0034
Open DOI Search in Google Scholar Back to article
Wang L, Cong HL, Zhang JX, Hu YC, Wei A, Zhang YY, et al. Triglyceride-glucose index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome. Cardiovasc Diabetol. 2020;19(1):80. DOI: 10.1186/s12933-020-01054-z
Open DOI Search in Google Scholar Back to article
Avagimyan A, Pogosova N, Fogacci F, Aghajanova E, Djndoyan Z, Patoulias D, et al. Triglyceride-glucose index (TyG) as a novel biomarker in the era of cardiometabolic medicine. Int J Cardiol. 2025;418:132663. DOI: 10.1016/j.ijcard.2024.132663
Open DOI Search in Google Scholar Back to article
Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, et al. Markers of inflammation and cardiovascular disease: Application to Clinical and Public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107(3):499–511. DOI: 10.1161/01.cir.0000052939.59093.45
Open DOI Search in Google Scholar Back to article
Kaptoge S, Di Angelantonio E, Lowe G, Pepys MB, Thompson SG, Collins R, et al. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. Lancet. 2010;375(9709):132–140. DOI: 10.1016/s0140-6736(09)61717-7
Open DOI Search in Google Scholar Back to article
Ruan GT, Xie HL, Zhang HY, Liu CA, Ge YZ, Zhang Q, et al. A Novel Inflammation and Insulin Resistance Related Indicator to Predict the Survival of Patients With Cancer. Front Endocrinol (Lausanne). 2022;13:905266. DOI: 10.3389/fendo.2022.905266
Open DOI Search in Google Scholar Back to article
Sun Y, Guo Y, Ma S, Mao Z, Meng D, Xuan K, et al. Association of C-reactive protein-triglyceride glucose index with the incidence and mortality of cardiovascular disease: a retrospective cohort study. Cardiovasc Diabetol. 2025;24(1):313. DOI: 10.1186/s12933-025-02835-0
Open DOI Search in Google Scholar Back to article
Zhang L, Li S, Liu D, Gui J, Hu J, Wang Q, et al. The relationship between C-reactive protein-triglyceride-glucose index and cardiovascular disease: insights from the China health and retirement longitudinal study (CHARLS). Cardiovasc Diabetol. 2025;24(1):410. DOI: 10.1186/s12933-025-02960-w
Open DOI Search in Google Scholar Back to article
Huo G, Tang Y, Liu Z, Cao J, Yao Z, Zhou D. Association between C-reactive protein-triglyceride glucose index and stroke risk in different glycemic status: insights from the China Health and Retirement Longitudinal Study (CHARLS). Cardiovasc Diabetol. 2025;24(1):142. DOI: 10.1186/s12933-025-02686-9
Open DOI Search in Google Scholar Back to article
Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10(2):77–84. DOI: 10.1016/S0749-3797(18)30622-6
Open DOI Search in Google Scholar Back to article
Zeng J, Qiu Y, Yang C, Fan X, Zhou X, Zhang C, et al. Cardiovascular diseases and depression: A meta-analysis and Mendelian randomization analysis. Mol Psychiatry. 2025;30(9):4234–4246. DOI: 10.1038/s41380-025-03003-2
Open DOI Search in Google Scholar Back to article
Jian H, Jie L, Jiang Y, Duan Y, Bing W, Liang R, et al. Synergistic effects of triglyceride-glucose index and body mass index combined with depression in predicting stroke events: a study based on two national cohorts. Front Nutr. 2025;12:1633655. DOI: 10.3389/fnut.2025.1633655
Open DOI Search in Google Scholar Back to article
Tian X, Yang X, Cao Y, Qu Z, Zhang B. Association between the depression and cardiovascular risk in arthritis patients: a prospective cohort study from the CHARLS database. Front Immunol. 2025;16:1590483. DOI: 10.3389/fimmu.2025.1590483
Open DOI Search in Google Scholar Back to article
Pariante CM, Lightman SL. The HPA axis in major depression: classical theories and new developments. Trends Neurosci. 2008;31(9):464–468. DOI: 10.1016/j.tins.2008.06.006
Open DOI Search in Google Scholar Back to article
Kuckuck S, Lengton R, Boon MR, Boersma E, Penninx BWJH, Kavousi M, et al. Long-term glucocorticoids in relation to the metabolic syndrome and cardiovascular disease: A systematic review and meta-analysis. J Intern Med. 2024;295(1):2–19. DOI: 10.1111/joim.13739
Open DOI Search in Google Scholar Back to article
Björntorp P, Rosmond R. Neuroendocrine abnormalities in visceral obesity. Int J Obes Metab Disord. 2000;24 Suppl 2:S80–S85. DOI: 10.1038/sj.ijo.0801285
Open DOI Search in Google Scholar Back to article
Oo WJ, Lim CL, Goh MH, Koh RY. Serum Cortisol and Cardiovascular Disease Risk – A Potential Biomarker. Curr Cardiol Rev. 2025;21(3):e1573403X328499. DOI: 10.2174/011573403x328499241106064553
Open DOI Search in Google Scholar Back to article
Howren MB, Lamkin DM, Suls J. Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosomatic Medicine. 2009;71(2):171–186. DOI: 10.1097/PSY.0b013e3181907c1b
Open DOI Search in Google Scholar Back to article
Dantzer R, O’Connor JC, Freund GG, Johnson RW, Kelley KW. From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosc. 2008;9(1):46–56. DOI: 10.1038/nrn2297
Open DOI Search in Google Scholar Back to article
Zhang N, Xie L, Zhang S, Wang Q, Lu H, Xiong Z, et al. Inflammatory storm and metabolic disorders: unraveling heterogeneity in mortality risk for comorbid diabetes mellitus and heart failure via the C-reactive protein-triglyceride-glucose index. Front Endocrinol (Lausanne). 2025;16:1689238. DOI: 10.3389/fendo.2025.1689238
Open DOI Search in Google Scholar Back to article
Cheng N, Ma Z, Chen Y, Jin L, Chen L. C-reactive protein-triglyceride glucose index and heart failure in US adults from NHANES 2001–2010. Sci Rep. 2025;15(1):26363. DOI: 10.1038/s41598-025-08389-1
Open DOI Search in Google Scholar Back to article
Xu X, Liu J, Sun Y, Sun P, Yu X. The association between the C-reactive protein-triglyceride-glucose index and cardiovascular diseases: A cohort study using data from the China Health and Retirement Longitudinal Study 2011–2020. PLoS One. 2025;20(12):e0335916. DOI: 10.1371/journal.pone.0335916
Open DOI Search in Google Scholar Back to article
Gao A, Peng B, Gao Y, Yang Z, Li Z, Guo T, et al. Evaluation and comparison of inflammatory and insulin resistance indicators on recurrent cardiovascular events in patients undergoing percutaneous coronary intervention: a single center retrospective observational study. Diabetol Metab Syndr. 2025;17(1):157. DOI: 10.1186/s13098-025-01687-8
Open DOI Search in Google Scholar Back to article
Zheng R, Wang T, Liu M, Cao X. Relationship between C-reactive protein triglyceride glucose index and cardiovascular disease risk: a cross-sectional analysis with machine learning. BMC Med Inform Decis Mak. 2025;25(1):424. DOI: 10.1186/s12911-025-03265-4
Open DOI Search in Google Scholar Back to article
Sun T, Zhang M, Liu J, An Z. Association between C-reactive protein-triglyceride glucose index and all-cause mortality and premature death: a joint analysis based on case data from the Central Hospital of Shaoyang and CHARLS database. Front Med (Lausanne). 2025;12:1656187. DOI: 10.3389/fmed.2025.1656187
Open DOI Search in Google Scholar Back to article
Li J, Tian X, Zhao D, Zhong L. Change in C-reactive protein-triglyceride glucose index and risk of stroke among middle-aged and older adults free of diabetes: A national cohort study. Nutr Metab Cardiovasc Dis. 2025;35(12):104372. DOI: 10.1016/j.numecd.2025.104372
Open DOI Search in Google Scholar Back to article
Yang Y, Liu A. Associations of cumulative exposure and dynamic trajectories of the C-reactive protein-triglyceride-glucose index with incident stroke in middle-aged and older Chinese adults: a longitudinal analysis based on CHARLS. Cardiovasc Diabetol. 2025;24(1):386. DOI: 10.1186/s12933-025-02945-9
Open DOI Search in Google Scholar Back to article
Tian X, Qu Z, Yang X, Cao Y, Zhang B. Synergistic effects of body fat percentage and C-reactive protein triglyceride-glucose index on cardiovascular disease risk: a Chinese cohort study. Sci Rep. 2025;15(1):40266. DOI: 10.1038/s41598-025-24094-5
Open DOI Search in Google Scholar Back to article
Chen Y, Jia W, Guo J, Yang H, Sheng X, Wei L, et al. Association between the C-reactive protein-triglyceride glucose index and new-onset coronary heart disease among metabolically heterogeneous individuals. Cardiovasc Diabetol. 2025;24(1):316. DOI: 10.1186/s12933-025-02876-5
Open DOI Search in Google Scholar Back to article
Huang C, You H, Zhang Y, Li Z, Li M, Feng X, et al. Association between C-reactive protein-triglyceride glucose index and depressive symptoms in American adults: results from the NHANES 2005 to 2010. BMC Psychiatry. 2024;24(1):890. DOI: 10.1186/s12888-024-06336-4
Open DOI Search in Google Scholar Back to article
Jiang C, Zheng Z, Su Y, Fu W, Zhong Q. Association of C-reactive protein-triglyceride glucose index with anxiety in American adults: outcomes from NHANES 2007 to 2010. Eur J Med Res. 2025; DOI: 10.1186/s40001-025-03555-7
Open DOI Search in Google Scholar Back to article
Glymour MM, Avendano M. Can self-reported strokes be used to study stroke incidence and risk factors?: evidence from the health and retirement study. Stroke. 2009;40(3):873–879. DOI: 10.1161/strokeaha.108.529479
Open DOI Search in Google Scholar Back to article
Xie W, Zheng F, Yan L, Zhong B. Cognitive Decline Before and After Incident Coronary Events. J Am Coll Cardiol. 2019;73(24):3041–3050. DOI: 10.1016/j.jacc.2019.04.019
Open DOI Search in Google Scholar Back to article
Ning M, Zhang Q, Yang M. Comparison of self-reported and biomedical data on hypertension and diabetes: findings from the China Health and Retirement Longitudinal Study (CHARLS). BMJ Open. 2016;6(1):e009836. DOI: 10.1136/bmjopen-2015-009836
Open DOI Search in Google Scholar Back to article

Authors

Additional files

Metrics

Articles in this issue

DOI: https://doi.org/10.5334/gh.1565 | Journal eISSN: 2211-8179

Journal RSS Feed

Language: English

Page range: 47 - 47

Submitted on: Mar 23, 2026

Accepted on: Jun 4, 2026

Published on: Jun 17, 2026

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Keywords:

cumulative C-reactive protein–triglyceride glucose index,

depression,

cardiovascular disease,

cohort study

© 2026 Qinxian Tu, Zhuoxuan He, Yizhuo Duan, Xiongjing Jiang, Hui Dong, Yubao Zou, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 21 (2026): Issue 1