Awareness and perceptions on the role of systemic inflammation in atherosclerotic cardiovascular disease and chronic kidney disease: a national study among cardiologists and nephrologists in China

Abstract Background Atherosclerotic cardiovascular disease (ASCVD) is among the leading causes of death in China even with advanced evidence-based treatments1. Systemic inflammation (SI) is a cardiovascular (CV) risk factor that significantly contributes to the development and progression of ASCVD and chronic kidney disease (CKD)2,3. High-sensitivity C-reactive protein (hsCRP) serves as a biomarker for SI, and its prognostic value for CV risks is increasingly recognised by clinical guidelines4,5. However, the clinical awareness and perceptions towards role of SI and hsCRP as a biomarker among Chinese cardiologists and nephrologists remain understudied. Purpose The SPARK-CVD China, a real-world, cross-sectional survey aimed to assess the awareness and perceptions towards the role of SI and hsCRP as a biomARKer for SI in patients with ASCVD and CKD among Chinese cardiologists and nephrologists. Methods A nationwide cross-sectional survey-based study was conducted from September to December 2024. Participants included cardiologists and nephrologists from 31 provinces across mainland China, treating at least 20 adult patients with ASCVD and CKD monthly, with over three years of clinical practice experience. Data analysis used descriptive statistics. Results A total of 1,500 eligible physicians (1,200 cardiologists and 300 nephrologists) completed a 25-minute survey. The CV risk factors most discussed with patients were hypertension, hyperglycaemia, and hyperlipidaemia by ~90% of respondents, while SI was discussed by only 35.2%. 73.3% of respondents recognised SI as a key driver for cardiovascular events, 69.8% acknowledged that residual inflammatory risk persisted even with evidence-based therapies, and 64.9% considered that SI was an independent risk factor for developing ASCVD. The majority of respondents (65.2%, n = 978) who tested for SI considered the results crucial for managing ASCVD and CKD. These results significantly influenced the aggressiveness of treating risk factors of ASCVD (79.6%), ASCVD (78.0%) and CKD (75.0%). Limited SI awareness, delays in diagnosis, and high risk of CV events and related complications were the top 3 identified unmet needs when treating patients with ASCVD and CKD (Figure 1). hsCRP (87.7%) was the most reported biomarker for SI. 68.0% of respondents stated the appropriate hsCRP threshold for SI diagnosis could be a certain value "≥2mg/L". Top factors for establishing hsCRP testing in standard of care for SI assessment included proven clinical efficacy (49.7%) and recommendation by clinical guidelines (37.7%) (Figure 2). Conclusion In this survey, SI was recognised as an independent CV risk factor, although not on the same level as traditional ones. Improving understanding of SI and hsCRP as a biomarker might be crucial for supporting physicians to make treatment decisions for patients with ASCVD and CKD in China.Figure 1:Unmet needs Figure 2:Factors to establish as SoC