Global prevalence of elevated high-sensitivity C-reactive protein in patients with atherosclerotic cardiovascular disease, with and without chronic kidney disease: findings from the POSEIDON study

BACKGROUND AND AIMS: Inflammation is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Contemporary global data on the prevalence of high inflammatory risk (high-sensitivity C-reactive protein [hsCRP] ≥2 mg/L), remain limited. We evaluated the global prevalence and characteristics of patients with high inflammatory risk among ASCVD patients, with and without chronic kidney disease (CKD). METHODS: ); also assessed were factors associated with hsCRP ≥2 mg/L and the correlation between hsCRP and interleukin (IL)-6. RESULTS: Among ASCVD patients with CKD (n = 5757; mean age 75 years, 25.9% women), 39.3% had elevated hsCRP; among those without CKD (n = 7718, mean age 67 years, 21.6% women), 28.3% had elevated hsCRP. Factors associated with hsCRP ≥2 mg/L were smoking, high body mass index, comorbid autoimmune disease, heart failure, polyvascular disease, and dyslipidaemia in both groups, and female sex and hypertension in those without CKD. IL-6 levels were significantly higher in patients with hsCRP ≥2 mg/L than without for both groups. Variability was observed in the prevalence of elevated hsCRP by country/region. CONCLUSION: High inflammatory risk is common, affecting ∼30% of patients with ASCVD globally and ∼40% of those with concomitant CKD, despite standard therapies. Routine hsCRP assessment may help characterize inflammatory risk, with implications for optimizing current preventive strategies, while awaiting potential benefits of future targeted therapies in these high-risk patients.