Higher coronary artery calcification (CAC) burden was observed in individuals with both metabolic syndrome (MetS) and elevated high-sensitivity C-reactive protein (hs-CRP) in a cross-sectional analysis published in Frontiers in Cardiovascular Medicine. CAC is a marker of subclinical atherosclerosis and is associated with coronary artery disease (CAD).

This cross-sectional study included 1,948 adults (mean age 49 years; 78% male) who underwent computed tomography-based coronary calcium scoring during routine health evaluations. Participants were categorized according to MetS status and hs-CRP levels (<0.3 vs ≥0.3 mg/dL). Multivariate logistic regression analysis adjusted for age, sex, and clinical variables was used to assess associations with CAC.

The analysis showed that the MetS(+)/high hs-CRP group had the highest Agatston scores. CAC prevalence increased with the number of MetS components, ranging from 44.5% to 100%. Among individual 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) showed the strongest associations with CAC. Elevated hs-CRP was independently associated with CAC (aOR 1.631; 95% CI 1.205-2.208), with a trend toward higher odds per 1 mg/dL increase (aOR 1.360; 95% CI 0.990-1.869).

Compared with the MetS(−)/low hs-CRP group, CAC odds 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). These findings indicate that MetS showed a stronger association with CAC than hs-CRP, while hs-CRP demonstrated an incremental association.