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A simple blood test for inflammation may predict cardiovascular risk in people with high blood pressure up to 20 years in advance.

A major new study led by researchers at Imperial's National Heart and Lung Institute, and published in  draws on longitudinal data from 5,294 participants in the UK arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT Legacy). The investigators examined baseline levels of high-sensitivity C-reactive protein (hsCRP), a hepatic acute-phase protein that reflects systemic inflammation.

A Modest Elevation, a Major Risk

The analysis showed that individuals in the highest tertile of hsCRP levels faced a 25–30% greater risk of myocardial infarction, stroke, or all-cause mortality over the 20-year follow-up period compared to those in the lowest tertile. Notably, even a modest elevation in hsCRP at baseline conferred excess cardiovascular risk, despite participants appearing otherwise healthy at enrolment.

While hsCRP was not associated with stroke incidence over the long term, suggesting a different pathophysiological basis for cerebrovascular events, it was a powerful independent predictor of coronary and overall mortality. The authors highlight that the incorporation of hsCRP into conventional risk models improved prognostic discrimination by nearly 10%, supporting its potential utility in routine cardiovascular risk stratification.

The Synergy of Lipids and Inflammation

A particularly striking finding was that the concurrent elevation of both LDL-cholesterol and hsCRP conferred the highest risk of future adverse outcomes. In contrast, an isolated rise in cholesterol in the presence of low-grade inflammation (hsCRP < 2 mg/L) did not significantly raise risk. This supports the growing recognition that inflammation and lipid accumulation act synergistically in the atherogenic process and underscores the rationale for dual-pathway therapeutic strategies.

Towards Clinical Translation

The findings suggest that measuring hsCRP in patients with hypertension could inform earlier intervention strategies, including the initiation of statins or targeted anti-inflammatory therapies. Pilot studies are being considered to assess whether incorporating inflammatory profiling into hypertension management can reduce long-term cardiovascular events and mortality.

Professor Ramzi Khamis, Professor of Cardiology at the National Heart and Lung Institute, said, “This important work underscores the need to identify and target residual inflammatory risk in patients with coronary artery disease. We are now moving beyond cholesterol alone. At the recent Imperial Vulnerable Plaque and Patient Meeting  (VPM), we laid out a roadmap for future translational studies aimed at refining both diagnostic and therapeutic tools that address vascular inflammation. This study strengthens the case for integrating hsCRP-guided strategies into routine cardiovascular care, particularly in the context of hypertension.”

As cardiovascular medicine continues to evolve towards personalised prevention, the integration of simple, scalable biomarkers such as hsCRP into clinical workflows could play a critical role in identifying patients at greatest risk long before symptoms arise.

The work was supported by the British Heart Foundation, the Wellcome Trust and the Sansour Fund via Imperial Health Charity, with infrastructure provided by the NIHR Imperial Biomedical Research Centre (BRC).

This article has been adapted from a news article by the NIHR Imperial BRC.