Remnant cholesterol inflammation index may be a superior biomarker to C-reactive protein-triglyceride glucose index in predicting carotid atherosclerosis risk

We aimed to investigate and compare the performance of C-reactive protein-triglyceride glucose index (CTI) and remnant cholesterol inflammation index (RCII) in carotid atherosclerotic plaque (CAP) risk prediction.

We conducted a case-control study (2,888 age- and sex-matched pairs) and a prospective cohort study of 4,418 participants without CAP (median follow-up: 767 days). Multivariable logistic and Cox regression were used to assess the associations of CTI and RCII with CAP. Receiver operating characteristic (ROC), net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated.

In the case-control study, increased CTI (OR: 1.45, 95% CI: 1.16–1.80) and RCII (OR: 1.95, 95% CI: 1.66–2.29) were significantly associated with increased CAP risk. Similar associations with CAP were also observed in the cohort for CTI (HR: 1.79, 95% CI: 1.32–2.44) and RCII (HR: 2.02, 95% CI: 1.60–2.54). Moreover, adding CTI and RCII showed improvements in CAP risk prediction beyond the traditional model, with the area under the ROC curve of 0.681 for CTI, 0.704 for RCII and 0.702 for RCII+CTI (p < 0.05). RCII showed a superior ability to identify high-risk individuals with CAP compared with CTI, with a significant NRI of 0.119 (95% CI: 0.045–0.191) and IDI of 0.006 (95% CI: 0.002–0.011).

Both CTI and RCII were significantly associated with increased risk of CAP, and RCII may be a superior biomarker to CTI in CAP risk prediction. Future large-scale cohort studies are needed to validate the predictive value of CTI and RCII for subclinical atherosclerosis.

Not applicable.