Systemic Inflammation Among Adults with Diagnosed and Undiagnosed Cardiometabolic Conditions: a Potential Missed Opportunity for Cardiovascular Disease Prevention

Context: Systemic inflammation is associated with cardiovascular morbidity and mortality. Since inflammation is not screened in the population, the prevalence, particularly among individuals with undiagnosed cardiometabolic disease, is unclear.

Objective: To assess the prevalence of elevated inflammation using high sensitivity C-reactive protein (hs-CRP) (>0.30 mg/dL) in adults with no cardiometabolic disease, undiagnosed disease and diagnosed disease.

Methods: We conducted a cross-sectional analysis of the 2015-2020 National Health and Nutrition Examination Survey which allows for population estimates of the US population. Adults > = 20 years old were included. HsCRP levels >0.30 mg/dL represented inflammation. Individuals were classified into disease defined as having one or more of the following: diagnosed disease--diabetes, hypertension, hyperlipidemia, or obesity by diagnosis; undiagnosed disease (self-report of no doctor diagnosis but positive biomarker); no disease.

Results: 12,946 unweighted individuals representing 315,354,183 adults in the US population were assessed. The proportion of adults with systemic inflammation is 34.63%. The proportion of individuals aged 20 years and older with no disease, undiagnosed disease and diagnosed disease and inflammation was 15.1, 29.1 and 41.8%, respectively. When stratifying by race/ethnicity among individuals with elevated inflammation Non-Hispanic Black people have the highest prevalence (50.35%) in individuals with diagnosed disease followed by Hispanics (46.13%) and Non-Hispanic White people (40.15%) ( < 0.01). In logistic regressions adjusted for sociodemographic variables, individuals with undiagnosed cardiometabolic disease have an increased risk of elevated inflammation as measured by CRP (OR 2.38; 95%CI = 1.90-2.99).

Conclusion: In conclusion, a substantial proportion of the adult population, particularly minority and low socioeconomic populations, have elevated inflammation. Systemic inflammation may be a potential focus for disease prevention and disease progression in primary care.