Key result
Moderate to severe malnutrition linked to ~74% higher MACCE risk in CAD with high inflammation.
Why the study?
Does malnutrition assessed by the CONUT score, mediated by inflammation, predict MACCE in patients with coronary artery disease?
Cohort (n=16,154)
Does malnutrition assessed by the CONUT score, mediated by inflammation, predict MACCE in patients with coronary artery disease?
Hazard Ratio: 1.742 (95% CI 1.318–2.302)
p-value: p=<0.001
Malnutrition, as assessed by the CONUT score, is a significant predictor of MACCE in CAD patients, particularly in the presence of high inflammation (hsCRP ≥ 2 mg/L).
Background Nutritional status plays a critical role in the progression of cardiovascular diseases. The Controlling Nutritional Status (CONUT) score, based on albumin levels, total lymphocyte count, and total cholesterol, serves as an objective measure of nutritional assessment. However, the impact of low nutritional status on long-term prognosis in patients with coronary artery disease (CAD), and the potential role of inflammation in this process, remains insufficiently explored. Aims To investigate the combined effect of CONUT score and inflammation (hsCRP) on the risk of major adverse cardiovascular and cerebrovascular events (MACCE) in CAD patients. Methods and Results A total of 16,154 CAD patients were included in this study. Nutritional status was categorized into three groups based on the CONUT score: Normal (0-1), Mild Malnutrition (2-4), and Moderate to Severe Malnutrition (≥5). Both the CONUT score and hsCRP were identified as independent predictors of MACCE. Stratified analysis revealed that in patients with high levels of inflammation (hsCRP ≥ 2 mg/L), a higher CONUT score was associated with worse prognosis: Mild Malnutrition: (aHR: 1.343, 95% CI: 1.158-1.558); Moderate to Severe Malnutrition (aHR: 1.742, 95% CI: 1.318-2.302). Kaplan-Meier survival curves also confirmed these findings (log-rank P < 0.001). In contrast, no such association was observed in patients with low inflammation levels. Mediation analysis revealed that hsCRP significantly mediated 22.4% of the association between the CONUT score and MACCE. Furthermore, incorporating both the CONUT score and hsCRP into traditional risk models showed improved predictive performance for MACCE in CAD patients, as evidenced by higher AUC, NRI, and IDI indices. Conclusions In the presence of high inflammation, malnutrition may lead to a poor prognosis. Therefore, simultaneous assessment of nutrition and inflammation may improve long-term outcomes and offer a more comprehensive approach to CAD management.
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Sun et al. (2025) conducted a cohort in Coronary artery disease (CAD) (n=16,154). Malnutrition (CONUT score ≥ 2) vs. Normal nutritional status (CONUT score 0-1) was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCE) (aHR 1.742, 95% CI 1.318-2.302, p=<0.001). In CAD patients with high inflammation, moderate to severe malnutrition was associated with an increased risk of MACCE (aHR 1.742; 95% CI 1.318-2.302).
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