High-sensitivity C-reactive protein as a prognostic biomarker in cardiovascular diseases: implications for atherosclerosis, chronic kidney disease, and heart failure – a review

High-sensitivity C-reactive protein (hsCRP) is gaining recognition as an important prognostic biomarker in cardiovascular diseases (CVDs), including atherosclerotic CVD (ASCVD), with and without chronic kidney disease (CKD), and heart failure (HF). Evidence suggests that systemic inflammation, measured by hsCRP, is prevalent in individuals with ASCVD, CKD, and HF, and is linked to increased risk of cardiovascular events. This review explores the interconnectedness of ASCVD, CKD, and HF within the cardiovascular-kidney-metabolic axis, with systemic inflammation emerging as a common underlying driver. Prevalence estimates show that systemic inflammation (hsCRP ≥ 2 mg/L) is found in 38% to 59% of patients with ASCVD, in 42% to 65% of those with both ASCVD and CKD, and in over 50% in various HF cohorts. Elevated levels of hsCRP are consistently associated with higher rates of major adverse cardiovascular events and mortality across these populations. Although hsCRP is frequently found to carry prognostic value independent of traditional biomarkers such as low-density lipoprotein cholesterol, its clinical adoption in practice is held back in part by guideline variability, lack of standardized cutoffs, and debate over how results may change clinical management with currently available therapies. The review calls for further research to define optimal hsCRP thresholds, examines the role of hsCRP in cardiovascular risk assessment, and reviews the ongoing development programs for emerging anti-inflammatory therapies. Addressing systemic inflammation could become a cornerstone of CVD management, potentially reducing residual risk beyond traditional targets.