Low-grade chronic inflammation is associated with cardiovascular risk factors but does not improve atherosclerosis stratification by the SCORE2 risk score
A D'Aiello, F R Jimenez Trinidad, A Severino, S Morini, D Pedicino, L Genuardi, A Buffon, D Tarquini, A Ruggio, S Filomia, A De Ciutiis, A De Vita, M Brecciaroli, A Santoliquido, G LiuzzoAbstract
Background
Low-grade chronic inflammation is increasingly recognized as a key contributor to cardiovascular disease, yet its incremental value in risk stratification beyond established clinical scores remains uncertain.
Purpose
To evaluate the association between inflammatory biomarkers and cardiovascular risk factors, and to determine whether inflammatory markers improve atherosclerosis stratification beyond the SCORE2 risk algorithm.
Methods
Circulating levels of C-reactive protein (CRP) and interleukin-6 (IL-6) were measured in 1,000 participants enrolled in the Italian CV-PREVITAL study, a multicentre randomized clinical trial designed to compare the effectiveness of an educational mobile health (mHealth) intervention with usual care in reducing cardiovascular risk in a primary prevention population. Associations between CRP and IL-6 levels and classical cardiovascular risk factors, including dyslipidaemia, hypertension, and body mass index (BMI), among others, were analysed. Subclinical atherosclerosis was assessed by carotid and femoral echo-Doppler measurement of intima-media thickness (IMT). The incremental value of inflammatory markers over the SCORE2 risk score for atherosclerosis stratification was evaluated.
Results
Both CRP and IL-6 levels were significantly associated with adverse cardiometabolic profiles, including dyslipidaemia, elevated BMI, and hypertension. A significant correlation between inflammatory markers and IMT was also observed. Higher inflammatory burden was associated with increased estimated cardiovascular risk according to SCORE2. However, the addition of CRP and IL-6 to SCORE2 did not significantly improve discrimination or reclassification for subclinical atherosclerosis compared with SCORE2 alone, without modifying their potential role in event prediction.
Conclusions
Although low-grade chronic inflammation is closely associated with traditional cardiovascular risk factors and overall estimated risk, inflammatory biomarkers do not provide incremental value for atherosclerosis stratification beyond SCORE2 in a primary prevention setting.