ESC Congress 2026 Abstract · Oct 26, 2026
Higher hs-CRP predicts severe cardiovascular-kidney-metabolic syndrome stages: The NHANES 2015 – 2018 survey cycle
By Corsi D, Ali M, Agbaje A
Background: Cardiovascular-kidney-metabolic (CKM) syndrome, defined by the American Heart Association in 2023, represents a pathophysiological continuum spanning excess adiposity, metabolic dysfunction, chronic kidney disease (CKD), and cardiovascular disease (CVD). Systemic inflammation, as measured by high-sensitivity C-reactive protein (hsCRP), is mechanistically implicated across CKM component domains. However, the relationship between hsCRP and CKM stage severity has not been characterised in a nationally representative population. Purpose: To examine the association between hs-CRP and CKM syndrome stage severity in a nationally representative adult sample. Methods: We analysed data from adults (≥20 years) participating in the National Health and Nutrition Examination Survey (NHANES) 2015–2018. CKM stages (0–4) were assigned per 2023 AHA criteria, incorporating adiposity indices, metabolic risk factors, kidney function (CKD-EPI 2021 estimated glomerular filtration rate), urine albumin-to-creatinine ratio, 10-year CVD risk (PREVENT equation), and self-reported CVD history. Participants with hs-CRP ≥10 mg/L were excluded. Hs-CRP was modelled as continuous, binary (≥2 vs <2 mg/L), and clinical categories (<1, 1–<3, ≥3 mg/L). Missing covariates were addressed using multiple imputation. Associations were estimated via proportional odds regression, adjusted for age, sex, race/ethnicity, education, poverty-income ratio, heart rate, systolic and diastolic blood pressure, total cholesterol, fasting glucose, fasting insulin, smoking status, and sedentary time. Results: The population included 8,986 participants (mean age 50.4±17.7 years; 50.3% female). CKM stage prevalence is presented in Figure 1. Mean hs-CRP increased across CKM stages (1.19, 2.55, 2.65, 2.90, 2.90 mg/L respectively; p<0.001). In fully adjusted proportional odds models, each 1 mg/L increment in hs-CRP was independently associated with higher CKM stage (OR 1.11, 95% CI 1.09–1.14; p<0.001). Compared with hs-CRP <2 mg/L, hs-CRP ≥2 mg/L conferred OR 1.56 (95% CI 1.43–1.70; p<0.001). Using clinical risk categories, hs-CRP 1–<3 mg/L (OR 1.54, 95% CI 1.39–1.71) and hs-CRP ≥3 mg/L (OR 1.89, 95% CI 1.70–2.10) were independently associated with more advanced CKM stage versus hs-CRP <1 mg/L (all p<0.001). In multinomial models with sequential reference stages, hs-CRP showed strongest association with transition from CKM Stage 0 to 1 (OR 2.88, 95% CI 2.51–3.32 for ≥2 vs <2 mg/L), with only modest or null associations for later transitions. Conclusions: Among US adults, hs-CRP demonstrates a consistent, dose-dependent, and independently adjusted association with CKM syndrome stage severity across the full disease spectrum, with the strongest association at CKM onset. These findings support systemic inflammation as a common pathway and shared risk marker across the CKM continuum and a potential target for early risk stratification.Figure 1Figure 2