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Lookup NU author(s): Professor Vijay KunadianORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology.Aims Inflammation and hyperlipidaemia play a pivotal role in atherosclerotic cardiovascular disease (ASCVD), and inflammatory risk may outweigh cholesterol risk among statin-treated patients. However, it is unclear how these risks relate to ASCVD outcomes in a real-world population. Methods and results Observational study of 39 638 ASCVD adults in Stockholm’s healthcare (2007–21) who underwent routine testing for high-sensitivity C-reactive protein (hsCRP) and low-density lipoprotein cholesterol (LDL-C). Groups were defined by LDL-C (≥1.8 vs. < 1.8 mmol/L) and hsCRP (≥2 vs. < 2 mg/L): as low risk, high cholesterol risk (CR) alone, high inflammatory risk (IR) alone, and combined high cholesterol and inflammatory risk (CIR). Primary outcome was major adverse cardiovascular (CV) events (MACE); secondary outcomes included all-cause death, CV death, and heart failure (HF) hospitalization. Mean age at baseline was 69 years, 61% were men, 19.4% had chronic kidney disease (CKD), and 61% were receiving lipid-lowering therapy (LLT). Over follow-up (median 4.5 years), 5349 MACE, 7955 deaths (2088 CV deaths) and 4286 HF hospitalizations occurred. Compared with patients with low risk, those with IR or CIR experienced the highest MACE risk (HR 1.39; 95% CI 1.26–1.54 for CIR, HR 1.18; 1.05–1.33 for IR), followed by CR (HR 1.12; 1.01–1.24). Elevated hsCRP, with or without elevated LDL-C, was strongly associated with secondary outcomes, while CR alone was not. Patterns were generally consistent across CKD and LLT subgroups. Conclusion In routine care high inflammatory risk, alone or with high cholesterol risk, is a stronger predictor of adverse outcomes than high cholesterol alone.
Author(s): Mazhar F, Capodanno D, Hjemdahl P, Sjolander A, Gerward S, Mathisen J, Plunde O, Kunadian V, Jernberg T, Carrero J-J
Publication type: Article
Publication status: Published
Journal: European Heart Journal Open
Year: 2026
Volume: 6
Issue: 2
Print publication date: 01/03/2026
Online publication date: 17/02/2026
Acceptance date: 11/02/2026
Date deposited: 17/03/2026
ISSN (electronic): 2752-4191
Publisher: Oxford University Press
URL: https://doi.org/10.1093/ehjopen/oeag023
DOI: 10.1093/ehjopen/oeag023
Data Access Statement: The data underlying this article cannot be shared publicly due to the privacy of individuals who participated in the study. The data may be shared on reasonable request for academic research collaborations that fulfil GDPR as well as national and institutional ethics regula tions and standards by contacting Prof. Juan-Jesus Carrero (juan. jesus.carrero@ki.se)
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