Predictors of Elevated High-Sensitivity C-reactive Protein in a US Population with Atherosclerotic Cardiovascular Disease: Results from the National Health and Nutrition Examination Survey

Introduction: Evidence suggests that inflammation is causally related to ASCVD. Elevated levels of high-sensitivity C-reactive protein (hsCRP) may identify individuals most likely to benefit from emerging anti-inflammatory therapies but hsCRP is not measured routinely in clinical practice. Aims: To identify potential risk factors indicating elevated hsCRP in patients with ASCVD. Methods: This cross-sectional study using data from the 1999–2010 and 2015–2018 NHANES cycles included adults (≥ 20 years old) with self-reported ASCVD and available hsCRP levels, plus sex and race/ethnicity data. Elevated hsCRP was defined as hsCRP 2–10 mg/L. Following weighting towards the US population, risk factors were assessed using multivariate logistic regression. Results: In total, 3415 individuals with ASCVD were included. In the weighted population (n = 13,008,371), 54.5% had elevated hsCRP. Median hsCRP levels increased with increasing numbers of risk factors ( Figure 1 ). Characteristics of groups with and without elevated hsCRP are shown in Table 1 . Smoking (OR 1.78 [95% CI: 1.11, 2.87]; p = 0.018) and BMI (OR per unit increase: 1.10 [1.06, 1.15]; p < 0.001) were associated with higher odds of elevated hsCRP; receipt of metabolic medication (OR 0.55 [0.39–0.77]; p < 0.001) and male sex (OR 0.60 [0.44–0.83]; p = 0.002) were associated with lower odds of elevated hsCRP. Conclusion: In this analysis of US NHANES data, smoking, BMI and female sex were linked to elevated hsCRP. The greater the number of risk factors, the higher the hsCRP level. Targeted hsCRP screening should be considered to identify those most likely to benefit from emerging anti-inflammatory therapies.