Abstract Body (Do not enter title and authors here): Background: Abundant evidence has suggested that individuals with poor Cardiovascular-kidney-metabolic (CKM) health are at a heightened risk of adverse cardiovascular events. In patients with coronary heart disease, a considerable proportion has concurrent CKM, which warrants further attention.
Purpose: This study aimed to evaluate the prognostic significance of inflammatory and non-insulin-based insulin resistance biomarkers in patients with confirmed CHD and CKM syndrome.
Methods: Among 10724 consecutive patients admitted to our center for CHD in 2013, 9716 patients who met the diagnostic criteria for CKM syndrome were included in this study. The endpoint was the major cardiac and cerebrovascular event (MACCE). The optimal cut-offs of the indicators were determined by the receiver operating characteristic analysis.
Results: During a median follow-up of 5.05 years, 2019 cases of MACCEs were observed. At baseline, the mean age of the overall cohort was 58.4 ± 10.3 years, and 7467 (76.9%) patients were male. Multivariable Cox regression analysis revealed that elevation of any inflammatory biomarkers levels [including white blood cells, neutrophils, monocytes, platelets, neutrophil-to-platelet ratio, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic inflammatory response index, systemic inflammatory index, pan-immune-inflammation value (PIV) and high-sensitivity C-reactive protein] was significantly associated with an increased risk of 5-year MACCE (all P<0.05), while PIV demonstrated the relatively strongest association [hazard ratio (HR) 1.274, 95% Confidence Interval (CI) 1.161-1.397; P<0.001]. However, among the indicators of insulin resistance [including the triglyceride and glucose (TyG) index, TyG-body mass index, triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) and metabolic score for insulin resistance], only TG/HDL-C remained significant after adjusting for confounding factors, with a HR of 1.147 (95% CI 1.027-1.280; P<0.05).
Conclusions: This current study reveals that, multiple inflammatory biomarkers and TG/HDL-C have predictive significance for the long-term prognosis of CHD patients with CKM syndrome, suggesting the potential application of these indicators in the assessment among the high-risk population. Further investigation is warranted to determine whether targeted treatment of these biomarkers would be of benefit.