CAR serves as an independent predictor for new-onset CAD and coronary lesion severity, with predictive efficacy modulated by glucose metabolic states, being most pronounced in normoglycemic and diabetic patients while attenuated in prediabetic individuals.
Elevated CAR independently predicted new-onset coronary artery disease risk in the overall cohort after multivariate adjustment.
The highest CAR quartile (Q4) significantly increased CAD risk in normoglycemic individuals.
The highest CAR quartile (Q4) significantly increased CAD risk in diabetic mellitus patients.
The association between elevated CAR and CAD risk was attenuated in prediabetic individuals after adjustment.
CAR robustly correlated with CAD severity as measured by Gensini score in both prediabetic and diabetic patients.
The study cohort was divided into three subgroups based on glycemic status for stratified analysis.
This research suggests that a blood test ratio combining C-reactive protein (a marker of inflammation) and albumin (a marker of nutritional status), known as the CAR, can help predict whether a person has coronary artery disease (CAD) — a condition where arteries supplying the heart become narrowed or blocked. The study followed 1,489 patients who underwent a heart imaging procedure called coronary angiography, and found that higher CAR values were associated with greater likelihood of having CAD and more severe disease, even after accounting for other risk factors. Importantly, CAR performed better at predicting CAD than either CRP or albumin measured alone. The relationship between CAR and CAD risk varied depending on a person's blood sugar status. In people with normal blood sugar and in those with diabetes, having a high CAR (top quartile) was strongly associated with new-onset CAD — with the risk being particularly elevated in those with normal blood sugar (about 4 times higher odds) and moderately elevated in diabetics (about 2.3 times higher odds). In people with prediabetes, however, this risk association weakened once other factors were taken into account, though CAR still correlated with the severity of artery disease in this group. This research suggests that measuring CAR — a simple and inexpensive calculation from routine blood tests — could be a useful clinical tool for identifying patients at risk for coronary artery disease, particularly in those with normal blood sugar or established diabetes. The finding that the predictive value differs across blood sugar categories highlights the importance of considering metabolic context when interpreting this marker, and points to potentially different inflammatory mechanisms underlying CAD in people at different stages of glucose metabolism.
Han S, Chen L, Shu H, Zhao G, Zhang H, Li J, et al.. (2026). Relationship between C-reactive protein-to-albumin ratio and new-onset coronary artery disease and its severity in different glucose metabolic states: A retrospective cohort study.. Medicine. https://doi.org/10.1097/MD.0000000000049238