More than half of patients living with both atherosclerotic cardiovascular disease and chronic kidney disease in Tianjin, a major city in northern China, show signs of persistent systemic inflammation, and those patients face markedly worse outcomes, according to a large real-world study published in the journal Cardiology and Therapy. Using the Tianjin Health and Medical Data Platform, which integrates inpatient, outpatient, and mortality records from 82 hospitals, researchers tracked thousands of patients between 2016 and 2023 and found that inflammation was associated with a 42 percent higher adjusted risk of major adverse cardiovascular events and more than a twofold higher risk of death from any cause.
The study combined two complementary designs. A cross-sectional analysis estimated how common atherosclerotic cardiovascular disease, chronic kidney disease, and systemic inflammation were each year from 2020 to 2023, while a retrospective cohort study compared clinical outcomes and healthcare costs between patients with and without inflammation. Systemic inflammation was defined by a C-reactive protein or high-sensitivity C-reactive protein value of at least 2 mg/L, a threshold widely used in clinical research, after excluding test results attributable to acute events such as infections, recent hospitalizations, intensive care stays, or recent use of antibiotics, antivirals, corticosteroids, or immunosuppressive therapies.
The prevalence figures reveal a substantial and growing burden. Between 2020 and 2023, the identified prevalence of atherosclerotic cardiovascular disease in Tianjin rose from 16.7 percent of the population, or 1,950,655 of 11,698,516 people, to 24.3 percent, or 2,795,883 of 11,507,844 people. Among these cardiovascular patients, the proportion with chronic kidney disease increased slightly from 12.4 percent to 12.9 percent. Among patients with both conditions who had at least one eligible CRP or hsCRP test, roughly 56 percent met the definition of systemic inflammation, and that proportion remained stable across the study period.
For the cohort analysis, the researchers started with 3,413,926 individuals diagnosed with atherosclerotic cardiovascular disease, of whom 412,125 also had chronic kidney disease. After applying exclusion criteria, including a requirement that patients survive at least three months after their first CRP or hsCRP measurement and have no record of myocardial infarction, unstable angina, stroke, transient ischemic attack, or surgery-related hospitalization within 30 days before the index date, the final cohort included 39,760 patients with systemic inflammation and 16,225 without.
The two groups differed in important ways at baseline. Patients with inflammation were older and included a slightly higher proportion of women. They also carried a heavier burden of comorbidities, including hypertension, heart failure, liver disease, atrial fibrillation, malignant tumors, chronic obstructive pulmonary disease, and dementia, along with a greater history of prior cardiovascular events such as stroke, unstable angina, and myocardial infarction. Use of cardiovascular, anticoagulant, antihyperlipidemic, and glucose-lowering medications was also more common in the inflammation group, a pattern suggesting that these patients represented more clinically complex cases from the outset.
After adjustment for age, sex, comorbidities such as heart failure, diabetes, hypertension, and hyperlipidemia, and prior cardiovascular events, the associations with adverse outcomes remained pronounced. Cox proportional hazards models showed that patients with systemic inflammation had a 42 percent higher risk of 3-point major adverse cardiovascular events, comprising stroke, myocardial infarction, and cardiovascular death, with a hazard ratio of 1.42 and a 95 percent confidence interval of 1.38 to 1.47. The risk of expanded major adverse cardiovascular events, which additionally includes heart failure, was also elevated, with a hazard ratio of 1.28 (95 percent CI 1.24 to 1.31). Most strikingly, all-cause mortality was more than 2.5 times higher in the inflammation group, with a hazard ratio of 2.59 (95 percent CI 2.4 to 2.8).
The inflammatory burden extended beyond the cardiovascular system. Patients with systemic inflammation experienced greater progression of chronic kidney disease, including declines in kidney function of at least 40 percent, rapid progression defined as an eGFR decline exceeding 5 mL/min/1.73 m2 per year for three consecutive years, acute kidney injury, and severely elevated urine albumin-to-creatinine ratios of 300 mg/g or more. Rates of medical procedures, particularly dialysis, were also markedly higher in this group, underscoring that inflammation appears linked to outcomes across the broader cardiovascular-renal continuum rather than to heart disease alone.
The economic consequences were equally substantial. On average, patients with systemic inflammation experienced more than twice the number of hospitalizations per person-year and substantially longer hospital stays compared with patients without inflammation, along with roughly 1.6-fold more outpatient visits per person-year. Total healthcare costs per person-year were more than twofold higher. Median follow-up duration was comparable between the two groups, at 754 days versus 760 days, which strengthens the comparison of resource utilization over similar observation periods.
The authors caution that several limitations shape how these findings should be interpreted. As an observational study, residual and unmeasured confounding cannot be excluded, so the results demonstrate association rather than causation. The reliance on electronic medical records designed for routine care may have left key variables, such as socioeconomic status, incomplete, and CRP and hsCRP capture only part of the complexity of inflammatory pathways, potentially introducing misclassification. Because the dataset did not cover all hospitals in Tianjin while the total city population served as the prevalence denominator, prevalence figures may be underestimated, and the authors note that chronic kidney disease is often underdiagnosed in China. The findings from a single urban population in northern China may also not generalize to rural areas or regions with different demographic and healthcare characteristics.
Nevertheless, the study offers region-specific evidence on what the researchers describe as residual inflammatory risk, the cardiovascular risk that persists despite optimal conventional treatment. Elevated high-sensitivity C-reactive protein has long been associated with cardiovascular events, renal disease progression, and mortality in patients with atherosclerotic cardiovascular disease or chronic kidney disease, and prior studies have linked inflammation to greater healthcare utilization and accelerated kidney disease progression. The authors suggest that systemic inflammation may serve both as a prognostic marker for identifying high-risk patients and as a potential therapeutic target, noting that anti-inflammatory therapies have been shown in other research to reduce residual cardiovascular risk and slow chronic kidney disease progression. Within Tianjin’s healthcare system, the findings may support patient identification, risk stratification, and healthcare planning for a population in which inflammation, cardiovascular disease, and kidney disease increasingly overlap.
Subject of Research: The prevalence and clinical and economic burden of systemic inflammation among patients with coexisting atherosclerotic cardiovascular disease and chronic kidney disease in northern China
Article Title: Burden of Systemic Inflammation Among Individuals with Atherosclerotic Cardiovascular Disease and Chronic Kidney Disease in Northern China
Article References: Ren, H., Fugger, M., Wang, Y., Shen, Z., Liu, C., Hao, Y., Zhou, X., Liu, H., Zhou, Z., Chen, R., & Yang, M. (2026). Burden of Systemic Inflammation Among Individuals with Atherosclerotic Cardiovascular Disease and Chronic Kidney Disease in Northern China. Cardiology and Therapy, 15(3), 351-363. https://doi.org/10.1007/s40119-026-00467-3
Image Credits: AI Generated
DOI: 10.1007/s40119-026-00467-3
Keywords: systemic inflammation, atherosclerotic cardiovascular disease, chronic kidney disease, C-reactive protein, major adverse cardiovascular events, all-cause mortality, Tianjin, real-world data, healthcare costs, hsCRP, retrospective cohort, China
News Source: Jerry Hayes. (October 30, 2026). Systemic Inflammation Tied to Higher Death Risk in Heart and Kidney Disease Patients. Scienmag.
