Real-World Analysis of the Association Between Systemic Inflammation, Cardiovascular Events, and Economic Burden Among Patients with Atherosclerotic Cardiovascular Disease and Chronic Kidney Disease

Patients with atherosclerotic cardiovascular disease (ASCVD) and systemic inflammation (SI) or chronic kidney disease (CKD) have poorer outcomes than those without SI or CKD. This study evaluated the impact of both SI and CKD on major adverse cardiovascular events (MACE), healthcare costs, and healthcare resource utilization (HCRU) in patients with ASCVD. This retrospective cohort study examined the association between SI and revised MACE, healthcare costs, and HCRU among adult patients with ASCVD from the Komodo Healthcare Map®. CKD stage 3–4 was determined from claims or laboratory data. SI was defined as ≥ 1 high-sensitivity C-reactive protein (hsCRP) value of 2–10 mg/l (without SI, all hsCRP values < 2 mg/l). The primary endpoint, revised MACE, was defined as a composite of nonfatal myocardial infarction, nonfatal stroke, and all-cause mortality. Of 74,884 patients with ASCVD and ≥ 1 eligible hsCRP value, 8.5% had CKD stage 3–4, and 49.2% had SI. Patients with SI had a higher comorbidity index and a greater prevalence of obesity, hypertension, and type 2 diabetes than those without SI. Compared with patients with ASCVD without CKD or SI, SI alone was associated with a 24% higher risk (hazard ratio [HR] 1.24; 95% CI 1.15–1.34), CKD stage 3–4 with a 33% higher risk (HR 1.33; 95% CI 1.16–1.51), and both SI and CKD stage 3–4 with a 62% higher risk (HR 1.62; 95% CI 1.45–1.82) of revised MACE. In patients with ASCVD without CKD, total healthcare costs were $18,002 PPPY with SI vs. $15,070 PPPY without SI. In patients with ASCVD with CKD stage 3–4, costs were $26,089 PPPY with SI vs. $20,753 PPPY without SI. Across groups, SI was associated with higher HCRU. SI is associated with increased risk of MACE and higher total healthcare costs and HCRU in patients with ASCVD with or without CKD. Inflammation usually happens when the body needs to heal an injury or infection. Inflammation that keeps happening in your body over a long time is called sustained systemic inflammation. Systemic inflammation can cause harm instead of healing. We looked at the effect of systemic inflammation in almost 75,000 people with atherosclerotic cardiovascular disease (ASCVD). Some of these people also had chronic kidney disease (CKD). We found that people with ASCVD and systemic inflammation were more likely to have a heart attack, stroke, or die sooner. These people who had systemic inflammation also needed to visit doctors and hospitals more often and had higher doctor and hospital costs. Patients who also had CKD had an even higher risk of a heart attack, stroke, or dying sooner, as well as higher healthcare costs than patients who did not have CKD, and the additional presence of systemic inflammation increased that risk further. These results suggest that we should aim to develop and test treatments to lower inflammation in patients with ASCVD and CKD, an often understudied population, to determine if these therapies improve the patients’ health.