Subgroup and sensitivity analyses were performed to test heterogeneity and robustness.<h4>Results</h4>During a median follow-up of 15.31 years (IQR, 14.54-16.03 years), CTI was consistently associated with higher risks of CAD (HR per 1-SD: 1.23, 95% CI: 1.21-1.25), T2DM (1.88, 95% CI: 1.84-1.92), CKD (1.22, 95% CI: 1.19-1.25), and multimorbidity (1.59, 95% CI: 1.55-1.64), outperforming CRP and TyG individually. Here, CRP is linked to chronic kidney disease.