Abstract
Introduction
Atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD) represent major public health challenges that contribute substantially to morbidity, mortality, and healthcare expenditures worldwide. Systemic inflammation (SI) has been recognized as a key pathophysiological mechanism underlying disease progression in both conditions; however, real-world evidence regarding its prevalence and associated clinical and economic impact remains limited, particularly in China.Methods
A cross-sectional analysis estimated the prevalence of ASCVD, CKD, and SI, alongside a retrospective cohort study evaluating clinical and economic burden associated with SI among patients with coexisting ASCVD and CKD, using data from Tianjin Health and Medical Data Platform (THMDP). SI was defined as C-reactive protein (CRP) or high-sensitivity CRP (hsCRP) ≥ 2 mg/L after excluding values attributable to acute events. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) for major adverse cardiovascular events (MACE) and all-cause mortality.Results
Between 2020 and 2023, ASCVD prevalence increased from 16.7% to 24.3%, with CKD affecting 12-13% of these patients. Among patients with ASCVD-CKD and eligible CRP/hsCRP testing, about 56% had SI, and the proportion remained stable over time. The cohort study included 39,760 patients with SI and 16,225 without. SI was associated with significantly higher risk of 3-point MACE (HR 1.42, 95% CI 1.38-1.47), expanded MACE (HR 1.28, 95% CI 1.24-1.31), and all-cause mortality (HR 2.59, 95% CI 2.4-2.8). Patients with SI also experienced greater CKD progression, higher dialysis rates, more frequent hospitalizations, and higher medical costs.Conclusions
SI is highly prevalent among patients with ASCVD and CKD in northern China and is strongly associated with worse clinical outcomes and greater healthcare burden. These findings underscore the unmet need for strategies targeting SI to improve prognosis and reduce clinical burden in this high-risk population.