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

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/m; 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.