Comparing the prevalence of cardiovascular inflammation in women and men with atherosclerotic cardiovascular disease with and without chronic kidney disease: a sub-analysis of the POSEIDON study

Introduction Cardiovascular (CV) inflammation, defined as high-sensitivity C-reactive protein (hsCRP) ≥2 mg/L, is often present in individuals with atherosclerotic cardiovascular disease (ASCVD) with or without chronic kidney disease (CKD). However, there are limited data regarding disparities in the prevalence of CV inflammation between women and men, as well as potential demographic/clinical differences between groups with and without CV inflammation. The POSEIDON study was designed to assess the worldwide prevalence of CV inflammation among individuals with ASCVD or heart failure. Purpose To assess sex-specific differences in prevalence and risk factors for CV inflammation in individuals with ASCVD with or without CKD. Methods POSEIDON was a real-world, cross-sectional study that enrolled 18,904 individuals (2023–2025), including 13,475 with ASCVD, across 18 countries. Eligible individuals were aged ≥18 years with ASCVD with or without CKD (defined as estimated glomerular filtration rate [eGFR] <60 mL/min/1.73m2) and receiving routine care. ASCVD was defined as the presence of one or more of the following: coronary heart disease, cerebrovascular disease or symptomatic peripheral artery disease. Individuals with infections, hospitalizations or unplanned visits in the 60 days preceding the index date (defined as the date of informed consent) were excluded. Results The ASCVD with CKD group included 1490 women (26%) and 4267 men (74%), and the ASCVD without CKD group included 1668 women (22%) and 6049 men (78%). The prevalence of CV inflammation was higher in women than men. In the ASCVD with CKD group, the prevalence of CV inflammation was 42.5% for women and 38.1% for men. Similar CV inflammation prevalence findings were observed in the ASCVD without CKD group (33.4% for women, 26.9% for men). In both the ASCVD with and without CKD groups, men were more frequently current/former smokers, were more likely to receive lipid-lowering therapy (LLT) and had lower low-density lipoprotein cholesterol (LDL-C) than women, whereas women were older and had lower eGFR than men (Table 1; Table 2). Sex-related disparities were comparable across ASCVD groups with CV inflammation, irrespective of CKD status. Among men and women with ASCVD, with or without CKD, those with CV inflammation were more likely to be current/former smokers, have type 2 diabetes, have higher body mass index and LDL-C levels, and lower eGFR, and were less likely to receive LLT compared with those without CV inflammation. Conclusions In this large, contemporary, global cohort, CV inflammation was more prevalent in women than men with ASCVD, regardless of CKD status. Despite baseline differences, factors associated with CV inflammation were similar in both sexes. CV inflammation is highly prevalent in both men and women with ASCVD, and its detection may help identify patients who could benefit from anti-inflammatory therapies to address residual inflammatory risk.