Demographic, behavioral, dietary, and clinical predictors of high-sensitivity C-reactive protein: The National Health and Nutrition Examination Surveys (NHANES)

Abstract

Aims: High-sensitivity C-reactive protein (hs-CRP), a marker of inflammation, is associated with atherosclerosis, and recent studies indicate that therapies targeting inflammation are associated with reductions in cardiovascular risk. However, factors predictive of elevated hs-CRP in the general population have not been elucidated. Methods: In this cross-sectional study, multivariable logistic regression analysis was used to identify independent predictors of elevated hs-CRP (≥3 mg/L) utilizing the National Health and Nutrition Examination Survey (NHANES) 2015–2016 cycle. The model was verified using the independent NHANES 2017–2018 cycle. Candidate variables comprised demographic, behavioral, dietary, and clinical factors. The study included 5412 adults from the 2015–2016 cohort and 5856 adults from the 2017–2018 cohort. Results: Significant independent predictors of elevated hs-CRP included: older age (OR 1.09 per decade; 95 % CI 1.03–1.14; P = 0.024), female sex (OR 1.57; 95 % CI 1.36–1.80; P = 0.003), Black vs White race (OR 1.31; 95 % CI 1.10–1.56; P = 0.037), increased BMI (OR 1.12 per kg/m2; 95 % CI 1.10–1.14; P < 0.001), elevated white blood cell count (OR 1.21 per 1000 white blood cells/μL; 95 % CI 1.15–1.28; P = 0.002), and self-reported poor vs excellent health (OR 1.73; 95 % CI 1.04–2.22; P = 0.012). The model had excellent discrimination with a c-statistic of 0.77 in the 2015–2016 cycle and 0.76 in the 2017–2018 cycle. Conclusion: Older age, female sex, Black race, increased BMI, higher white blood cell count, and self-reported poor health were independent predictors of elevated hs-CRP levels. Additional studies are needed to determine if behavioral modifications can lower hs-CRP and whether this translates to reduced risk for cardiovascular disease and other conditions associated with chronic inflammation.

Keywords

• Chronic inflammation
• C-reactive protein
• Risk factors
• Cardiovascular disease