AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
C-Reactive Protein and Incidence of Symptomatic Peripheral Vascular Disease: Findings from the Multi-Ethnic Study of Atherosclerosis
By Akoum A, Wang C, Guo YY et al.
Introduction: Symptomatic peripheral vascular disease (sPVD), including peripheral artery disease and abdominal aortic aneurysm, carries substantial morbidity, yet risk stratification remains inconsistent. Systemic inflammation is central to atherosclerosis, but whether low-grade inflammation predicts incident sPVD is poorly characterized. We assessed high-sensitivity C-reactive protein (CRP) as an early biomarker for long-term sPVD in a population free of baseline cardiovascular disease. Methods: We performed a secondary analysis of the Multi-Ethnic Study of Atherosclerosis. Of 6,814 participants, 6,466 were analyzed after excluding those with missing CRP or outcome data, acute inflammation (CRP greater than 15 mg/L), or prevalent sPVD. CRP was categorized as low risk (less than 2 mg/L) or high risk (2 mg/L or greater). The primary outcome was physician-adjudicated incident sPVD. Kaplan-Meier and Cox regression estimated risk, adjusted for age, sex, body mass index, smoking, diabetes, hypertension, LDL cholesterol, and statin use. Smoothing splines assessed the continuous CRP relationship. Results: Over a median follow-up of 14.0 years, 112 sPVD events occurred. The high CRP group had more events than the low CRP group (72 vs 40; 2.4% vs 1.1%; p less than 0.001). Elevated CRP was associated with increased sPVD risk in unadjusted (HR 2.17; 95% CI 1.47 to 3.19; p less than 0.001) and adjusted analyses (HR 2.25; 95% CI 1.48 to 3.41; p less than 0.001). Age, sex, LDL cholesterol, smoking, hypertension, and diabetes were also associated with sPVD. BMI and statin use were not. The probability of sPVD increased progressively with rising CRP levels. Conclusions: In individuals free of cardiovascular disease, elevated CRP was independently associated with more than a two-fold higher risk of incident sPVD. CRP may identify at-risk individuals before ankle-brachial index abnormalities appear, supporting its use in early risk assessment for peripheral artery disease and abdominal aortic aneurysm.