Global high sensitivity C-reactive protein testing trends from 2014 to 2025
A Ahmed, V Jaiswal, M J Ricciardi, A QamarAbstract
Background
High sensitivity C-reactive protein (hs-CRP) is a well-established biomarker for residual inflammatory risk, identifying patients at increased risk for cardiovascular events despite achieving target LDL-C levels. Guidelines recognize hs-CRP as a key risk enhancer for both primary and secondary prevention. However, the current global trends in hs-CRP testing remain unknown.
Purpose
To evaluate global trends in hs-CRP testing and disparities in its utilization across key demographics and high-risk subgroups
Methods
This was a large-scale longitudinal study using the TriNetX Global Collaborative Network to identify a real-world cohort of patients aged ≥ 18 years between January 1st 2014 and December 31st 2025. We assessed annual trends in hs-CRP testing prevalence in the overall population and across high-risk subgroups including atherosclerotic cardiovascular disease (ASCVD), coronary artery disease (CAD), peripheral arterial disease (PAD), ischemic stroke, heart failure (HF), chronic kidney disease (CKD), obesity, and type 2 diabetes mellitus (T2DM). Temporal trends were analyzed using linear regression to determine the annual percentage increase and statistical significance (p-values). Demographic analyses were performed to evaluate differences in hs-CRP testing based on sex and race.
Results
Over 133 million patients from 171 healthcare organizations were included. Of these, 1,572,526 (1.2%) underwent hs-CRP testing (mean age: 59.3±18.8 years, females: 53.5%), while 131,592,899 (98.8%) did not. Between 2014 and 2025, the overall prevalence of hs-CRP testing increased nominally from 1.08% to 2.39% (annual increase: 0.098%; p<0.001) (Figure 1A). While both sexes experienced a significant rise in hs-CRP testing from 2014 to 2025 (p<0.001), there was no statistically significant difference in testing prevalence between males and females (p=0.690) (Figure 1B). Although hs-CRP testing increased among all races, Asian individuals demonstrated a significantly steeper increase from 5.31% in 2014 to 13.73% in 2025 (p<0.001) (Figure 1C). Among high-risk clinical subgroups, hs-CRP testing demonstrated a statistically significant but modest increase between 2014 and 2025 (ASCVD: 2.46%–6.27%; CAD: 2.55%–6.76%; PAD: 2.65%–6.70%; Ischemic stroke: 3.05%–6.93%; HF: 2.57%–6.21%; Family history of CAD: 2.70%–6.78%; Carotid stenosis: 3.02%–7.38%; Aortic stenosis: 2.76%–6.49%; CKD: 2.69%–6.27%; Obesity: 1.23%–3.08%; and T2DM: 2.10%–5.01%; p<0.001 for all), yet overall utilization remained considerably low with < 7.5% prevalence across all categories (Figure 1D).
Conclusion
Global hs-CRP testing rates remained low overall and across high-risk clinical subgroups, with persistent under-utilization observed regardless of sex and across most races. This emphasizes the need for enhanced clinician education and implementation of guideline-recommended testing and risk stratification.Figure 1