AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Inflammatory Cardiovascular Risk and Statin Use Among U.S. Adults with Normal LDL Cholesterol
By Kadiri O, Esho I
Background: Elevated high-sensitivity C-reactive protein (hs-CRP) is an established marker of chronic systemic inflammation and has been associated with increased cardiovascular disease (CVD) risk independent of lipid levels. However, the burden of inflammatory risk among U.S. adults with normal low-density lipoprotein cholesterol (LDL-C), and its relationship with statin therapy in the U.S. population remains incompletely characterized. Objectives: To examine the association between hs-CRP and prevalent cardiovascular disease among U.S. adults with normal LDL-C (<100 mg/dL), and to characterize the prevalence of elevated inflammation and statin use in this population. Methods: We performed a cross-sectional analysis of a nationally representative sample of 2,457 adults (≥20 years) from the National Health and Nutrition Examination Survey (NHANES) 2015-2020 with LDL-C <100 mg/dL. Elevated inflammation was defined as serum hs-CRP >3 mg/L. CVD history was defined as a self-reported history of congestive heart failure, coronary heart disease, angina, myocardial infarction, or stroke. Survey-weighted logistic regression assessed the association between log-transformed hs-CRP and CVD after adjusting for age, body mass index (BMI), diabetes status, and sex. The prevalence of elevated hs-CRP was calculated across racial and ethnic groups. Statin use was evaluated among individuals with elevated hs-CRP. Results: Among adults with LDL-C <100 mg/dL, each doubling of hs-CRP was associated with higher odds of prevalent CVD (OR 1.11, 95% CI 1.01-1.23; p < 0.05). Adults in the top quartile of hs-CRP (≥3.8 mg/L) had more than twice the odds of CVD compared with those in the bottom quartile (≤0.6 mg/L) (OR 2.03, 95% CI 1.21-3.40; p < 0.05). The prevalence of elevated hs-CRP varied by race and ethnicity, present in 34% of Mexican American, 35% of Non-Hispanic Black, and 27% of Non-Hispanic White adults, compared with 15% of Non-Hispanic Asian adults. Elevated hs-CRP was also more common in women than men (35% vs. 22%). Despite this inflammatory burden, the majority of adults were not on statin therapy: overall, only 35% with elevated hs-CRP reported statin use, with a significant gap between the secondary prevention group (70%) and the primary prevention group (27%). Conclusions: Among U.S. adults with normal LDL-C, higher hs-CRP was associated with greater odds of prevalent CVD. Elevated inflammation was common in this population and varied across racial/ethnic groups. Despite evidence that statins can reduce inflammatory risk, most adults with elevated hs-CRP were not receiving statin therapy. These findings highlight the potential value of inflammatory biomarkers in cardiovascular risk assessment and may inform future strategies for CVD prevention.