Prevalence and Characteristics of Systemic Inflammation in Adults with Atherosclerotic Cardiovascular Disease and Chronic Kidney Disease: Results from the National Health and Nutrition Examination Survey

Introduction: Systemic inflammation is linked to the development of atherosclerosis and the risk of major adverse cardiovascular events and mortality in adults with atherosclerotic CVD (ASCVD) and chronic kidney disease (CKD). Despite this, the epidemiology of systemic inflammation in this high-risk population has not been well described. Here, we estimate the prevalence of systemic inflammation in US adults with ASCVD with CKD, and characterize this population. Methods: Data were from the 2015-2020 pre-pandemic National Health and Nutrition Examination Survey (NHANES) cycles. Adults ≥ 20 years who completed the NHANES Medical Conditions Questionnaire and had non-missing serum creatinine and hsCRP levels, plus age, sex and ethnicity data, were included in this study. Systemic inflammation was defined as hsCRP ≥ 2 mg/L. To estimate prevalence in the US population, weighting was performed as outlined in the NHANES guidelines. Results: In total, 12 722 of 25 531 individuals met all the inclusion criteria. Based on weighted estimates, 8.4% of the general US population had ASCVD; of this group, 36.0% also had CKD and 22.1% had CKD stage 3/4. Systemic inflammation was present in 55.2% (95% CI, 49.8-60.6) of individuals with ASCVD, in 59.4% (53.4-65.2) with ASCVD and CKD, and in 62.1% (55.2-68.8) with ASCVD and CKD stage 3/4. The prevalence of individuals with systemic inflammation, ASCVD and CKD stage 3/4 among the US population was estimated at 1.2% (0.9-1.4). This group had a mean age of 72.1 years and a mean BMI of 31.9 kg/m 2 , 30.8% had type 2 diabetes and 38.9% had had an overnight hospital stay in the past 12 months ( Table ). A sensitivity analysis (patients with hsCRP 2-10 mg/L) had similar results. Conclusions: In this US survey, a large proportion of adults with ASCVD and CKD stage 3/4 had systemic inflammation. This group comprises an estimated 2.5 million adults who are likely to benefit from further targeted risk reduction efforts to help improve their cardiovascular outcomes.