Metabolic syndrome and high-sensitivity C-reactive protein co-modify the risk of coronary artery calcification

Background Coronary artery calcification (CAC) is a marker of subclinical atherosclerosis and is strongly associated with coronary artery disease (CAD). Metabolic syndrome (MetS) and high-sensitivity C-reactive protein (hs-CRP), an inflammatory marker, have each been linked to CAC, but their combined influence remains unclear. Methods This cross-sectional study included 1948 adults undergoing health checkups and coronary calcium scoring via computed tomography. Participants were grouped by MetS status and hs-CRP levels (<0.3 vs. ≥0.3 mg/dL). Multivariate logistic regression analysis was used to evaluate associations between MetS, hs-CRP, and CAC, adjusting for age, sex, and clinical variables. Results The cohort (mean age, 49 years; 78% male) was categorized into four groups: MetS(−)/low hs-CRP (74%), MetS(−)/high hs-CRP (10%), MetS(+)/low hs-CRP (12%), and MetS(+)/high hs-CRP (5%). The MetS(+)/high hs-CRP group had the highest Agatston score. CAC prevalence increased with the number of MetS components (from 44.5% to 100%). Among MetS components, high fasting glucose [adjusted odds ratio [aOR], 1.973; 95% confidence interval [CI], 1.526–2.551], hypertension (aOR, 1.674; 95% CI, 1.324–2.117), and high waist circumference (aOR, 1.492; 95% CI, 1.187–1.877) had the strongest associations with CAC. Elevated hs-CRP was independently associated with CAC (aOR, 1.631; 95% CI, 1.205–2.208), with a dose-response trend per 1 mg/dL increase (aOR, 1.360; 95% CI, 0.990–1.869). Compared to the MetS(−)/low hs-CRP group, the odds of CAC were highest in the MetS(+)/high hs-CRP group (aOR, 2.392; 95% CI, 1.470–3.891), followed by MetS(+)/low hs-CRP (aOR, 1.996; 95% CI, 1.426–2.795), and MetS(–)/high hs-CRP (aOR, 1.538; 95% CI, 1.067–2.218). Conclusions MetS showed a stronger association with CAC than hs-CRP, while hs-CRP appeared to confer a modest incremental association.