ESC Congress 2026 Abstract · Oct 26, 2026
The additive prognostic value of C-reactive protein for all-cause and cardiovascular mortality across the PREVENT-defined cardiovascular risk continuum: a nationally representative cohort study
By Jaiswal V, Bouras A, Jaiswal A et al.
Background: High-sensitivity C-reactive protein (hsCRP) is a recognized cardiovascular risk-enhancing factor, yet whether its prognostic value varies across the spectrum of baseline cardiovascular risk defined by the American Heart Association (AHA) PREVENT equations remains unknown. Purpose: To evaluate the additive prognostic value of hsCRP for all-cause and cardiovascular mortality across PREVENT-stratified risk groups in a nationally representative US cohort. Methods and Results: We analyzed 14,124 adults aged 30 to 79 years without baseline atherosclerotic cardiovascular disease (ASCVD) from the National Health and Nutrition Examination Survey (NHANES) 2003 to 2016, with mortality follow-up through December 31, 2019 (mean follow-up 10.2 years). Participants were stratified by PREVENT 10-year cardiovascular disease risk (low, borderline-intermediate, and high) and hsCRP category (less than 1, 1 to 3, greater than 3 mg/L). All-cause mortality was assessed using multivariable Cox proportional hazards models, and cardiovascular (CVD) mortality was assessed using cause-specific Cox models. During follow-up, 1,364 all-cause deaths (9.7%) and 335 CVD deaths (2.4%) occurred. For all-cause mortality, hsCRP greater than 3 mg/L was independently associated with increased risk in the borderline-intermediate risk group (hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.18 to 1.74, P = 0.0003) and the low risk group (HR 1.39, 95% CI 1.06 to 1.83, P = 0.018), but not in the high-risk group (HR 1.25, 95% CI 0.97 to 1.62, P = 0.085). For cardiovascular mortality, hsCRP greater than 3 mg/L was significantly associated only in the borderline-intermediate risk group (HR 1.46, 95% CI 1.05 to 2.01, P = 0.023). Adding hsCRP to the base covariate model improved discrimination in the borderline-intermediate group (change in C-statistic 0.0064, 95% CI 0.0014 to 0.0136) and the high risk group (change in C-statistic 0.0108, 95% CI 0.0010 to 0.0248), but not in the low risk group. Conclusion: Elevated hsCRP confers additive prognostic value for mortality primarily among adults at borderline-intermediate PREVENT-defined cardiovascular risk, the population segment where clinical decision-making regarding preventive therapy is most uncertain. These findings support the targeted use of hsCRP as a risk-enhancing factor in this population.