Joint Effect of hsCRP and CVD Risk Factors on Cardiovascular Disease Risk in Finnish Adults

Abstract Background We aimed to assess the joint effect of high-sensitivity C-reactive protein (hsCRP) and the accumulation of cardiovascular disease (CVD) risk factors on the risk of CVD. Methods We used pooled cross-sectional data from five Finnish health examinations surveys: Health 2000, FINRISKs 2002, 2007 and 2012, and FinHealth 2017. The study population consisted of 23 634 adults aged 30-74 years. CVD risk factors included smoking, elevated LDL cholesterol and elevated blood pressure. The joint effect of hsCRP and these risk factors was categorized into four groups: no CVD risk factors, 1, 2, and 3 CVD risk factors. The average follow-up time across all studies was 14.42 years, with 2 368 prevalent cases. Cox proportional hazard models adjusted for age, statins, diabetes medication, HbA1c and abdominal obesity were performed. The reference group for hazard ratios was participants with no CVD risk factors and hsCRP levels <2 mg/L. Results Among the participants, 25% of men and 30% of women had hsCRP levels of ≥ 2 mg/l. In men, elevated hsCRP levels (≥2 mg/L) doubled the risk of any CVD, even without other CVD risk factors (HR 2.2, 95% CI 1.48-3.27). The risk increased with the number of CVD risk factors: with two, the HR was 2.63 (95% CI 1.97-3.51), and with three, it was 4.0 (95% CI 2.88-5.54). In women, elevated hsCRP alone was not associated with an increased risk (HR 1.38, 95% CI 0.92-2.05). However, the presence of even one CVD risk factor significantly raised the risk associated with high hsCRP levels (HR 1.497, 95% CI 1.12-1.99). With all three risk factors, the HR was 2.3 (95% CI 1.49-3.54). Conclusions Elevated hsCRP levels and traditional CVD risk factors jointly increase the risk of developing CVD. In men, elevated hsCRP levels independently double the risk of any CVD, with further increases from additional CVD risk factors. In women, elevated hsCRP alone does not significantly increase the risk, but the presence of CVD risk factors heightens the risk. Key messages • Elevated hsCRP levels (≥2 mg/L) significantly increase CVD risk in men, even without other risk factors. In women, high hsCRP levels amplify CVD risk only with traditional risk factors. • These findings emphasize the importance to consider both hsCRP levels and traditional CVD risk factors in risk assessment and prevention strategies to improve public health outcomes.