CV inflammation prevalence and clinical biomarkers (hsCRP, IL-6 and NT-proBNP) levels in adults with ASCVD and CKD in KSA and UAE: Insights from the INFLAMEAST real-world study
M Alasnag, W Almahmeed, J Alali, F Elmula M Fadl-Elmula, W Ezzat Nafee Farag, H Heshmat, T Al Jumaili, L Samih, A Almasood, F Alqahtani, A Nasir Mohamed Ali Al Zaabi, H Aly, M Mathias, I Tawfik, L TokgozogluAbstract
Introduction
Inflammation drives atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD) development, progression and cardiovascular (CV) inflammation by persistent immunological activation causing health burden. Elevated blood biomarkers, like high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), N-terminal pro-B-type natriuretic peptide (NT-proBNP) highlight patients’ heightened susceptibility to progressive risk of CV events due to inflammation and disease progression. Routine hsCRP-testing and comprehensive data on CV inflammation prevalence and biomarker levels in ASCVD+CKD patients in the Kingdom of Saudi Arabia (KSA) and United Arab Emirates (UAE) remain limited.
Purpose
The INFLAMEAST study assessed the CV inflammation prevalence measured by hsCRP ≥2 mg/L, associated biomarkers levels (IL-6 and NT-proBNP), demographics and clinical characteristics in the ASCVD+CKD cohort.
Methods
This was an observational, cross-sectional study in adults with ASCVD+CKD from 20 sites in KSA and UAE. Data were collected from Nov 2024 to Aug 2025 via single visit including blood sampling. Endpoints focused on identifying CV inflammation by measuring hsCRP and IL-6, examining NT-proBNP stratified by the presence of CV inflammation (hsCRP ≥2 mg/L), and demographics and clinical characteristics.
Results
Of 641 patients in the full analysis set, 352 were included in ASCVD+CKD cohort (KSA: n=181; UAE: n=171). The median age was 70 years, BMI was 28 kg/m2, and 79% had type 2 diabetes. Overall, CV inflammation prevalence was 51.4% (CI:46-57) and consistent across countries (KSA: 52.5% [CI:45-60]; UAE: 50.3% [CI:43-58]) Figure 1. Overall, median (Q1; Q3) levels of IL-6 and NT-proBNP were 4.86 (3.05; 8.71) and 388.5 (155; 1185) pg/mL, respectively. hsCRP stratified levels (≥2 vs <2 mg/L) showed higher overall median IL-6 (7.1 vs 3.8 pg/mL) and NT-proBNP (474 vs 365 pg/mL) in higher hsCRP-subgroup with similar trend across countries Table 1. Overall, hsCRP levels were 2-5 mg/L in 27% (n=95), 5-10 mg/L in 13% (n=45) and 10-20 mg/L in 7% (n=26) of patients. Median (Q1;Q3) LDL-c level was 55 (37; 82) mg/dL. Most patients were on lipid-lowering therapies: 81% on statins, 6% on statins-ezetimibe, 41% on ezetimibe and 17% on PCSK9-inhibitors in higher hsCRP-subgroup. Despite achieving guideline recommended LDL-c levels (<55 mg/dL), 47% of patients on LDL-c targeted therapy and 57% on efficacious PCSK9-targeted-therapies, still exhibited CV inflammation and potential residual risk linked to it.
Conclusions
In ASCVD+CKD cohort, CV inflammation was prevalent in approximately half of patients. Measuring hsCRP identifies significant CV inflammation, with higher levels of IL-6 and NT-proBNP in patients with elevated hsCRP. Many well-controlled LDL-c patients showed inflammation, highlighting necessity of routine hsCRP-testing to improve risk-stratification beyond LDL-c control.