Association between Smoking Status, High-sensitivity C-reactive Protein, and Dyslipidemia: Analysis Using the 9th Korea National Health and Nutrition Examination Survey

Smoking promotes systemic inflammation and adverse lipid profiles, but nationally representative evidence in Korean adults remains limited.This study analyzed 6,721 adults aged 19~69 years using the KNHANES 2022~2023 data.Smoking was classified as never, former, or current; high-sensitivity C-reactive protein (hs-CRP) was classified as <1.0, 1.0~<3.0,or 3.0 mg/L.The dyslipidemia outcomes included overall dyslipidemia and four subtypes.Survey-weighted logistic regression with staged adjustment estimated the odds ratios (ORs).Current smoking was strongly associated with overall dyslipidemia (OR=1.50,P<0.001), particularly hypertriglyceridemia (OR=2.31)and low high-density lipoprotein (HDL)-cholesterol (OR=2.02).By contrast, the associations with hypercholesterolemia and high low-density lipoprotein-cholesterol were inconsistent.Stratified analyses revealed differential hs-CRP-dyslipidemia associations according to the smoking status.Among current smokers, intermediate hs-CRP (1.0~<3.0mg/L) was associated with hypercholesterolemia (OR=2.05,P=0.007), hypertriglyceridemia (OR=1.73,P=0.008), and low HDL-cholesterol (OR=2.05,P=0.001); high hs-CRP (3.0 mg/L) remained linked to low HDL-cholesterol (OR=2.55,P=0.003).Among the never smokers, hs-CRP was associated most strongly with low HDL-cholesterol (intermediate: OR=2.24; high: OR=2.71; both P<0.001).These findings support an inflammation-lipid axis that is amplified in current smokers and suggest that hs-CRP may help stratify the cardiovascular risk in primary care.