Associations of the hs-CRP/HDL-C ratio with cardiovascular metabolic multimorbidity: a large cross-sectional study

Why this study matters for everyday health

Many older adults live with more than one long-term condition such as high blood pressure, diabetes, heart disease, or stroke at the same time. This “stacking” of problems greatly shortens life expectancy and raises the risk of disability. The featured study asks a simple but powerful question: can a single, easy-to-measure blood marker capture a person’s combined risk for developing several of these cardiometabolic diseases together, and point to ways to prevent them earlier?

A combined signal from inflammation and "good" fat particles

Doctors already measure two blood components in routine checkups. One is high-sensitivity C-reactive protein, which rises when there is low-level, long-lasting inflammation in the body. The other is high-density lipoprotein cholesterol, often called “good” cholesterol because it helps protect blood vessels. The researchers focused on the ratio between these two measures, viewing it as a single index that blends the body’s inflammatory burden with the status of protective blood fats. They reasoned that this ratio might better reflect the overall strain on the heart and metabolism than either value alone.

Tracking multiple heart and metabolic illnesses in a large population

The team used data from more than 8,600 middle-aged and older adults who took part in a nationwide Chinese health survey. Participants had detailed interviews, medical exams, and blood tests. The scientists grouped people according to whether they had at least two of four common conditions: high blood pressure, diabetes, coronary heart disease, or stroke. Those with two or more were classified as having cardiometabolic multimorbidity, while everyone else formed the comparison group. They then examined how the inflammation–cholesterol ratio related to having this cluster of illnesses, while taking into account age, sex, where people lived, education, smoking, drinking, and sleep.

Higher ratio, higher chance of multiple illnesses

People with multiple cardiometabolic conditions tended to be older, heavier, and to show a more disturbed blood profile: more inflammatory cells, higher uric acid and total cholesterol, higher blood sugar and long-term sugar marker (HbA1c), more inflammation, and lower “good” cholesterol. Their combined hs-CRP/HDL-C ratio was clearly higher than in those without multimorbidity. When the researchers ran statistical models, each step up in this ratio was linked with more than double the odds of having several cardiometabolic diseases. Those in the highest quarter of the ratio distribution had over three times the odds of multimorbidity compared with those in the lowest quarter, even after adjusting for social and lifestyle factors. The relationship was not simply a straight line: risk climbed as the ratio increased within the usual range, then appeared to level off beyond a certain threshold.

How long-term blood sugar fits into the picture

The study also explored how long-term blood sugar control, captured by the HbA1c test, might sit between the inflammation–cholesterol ratio and multimorbidity. Using mediation analysis, the authors found that about half of the association between the ratio and having multiple conditions seemed to operate through differences in HbA1c. In other words, a higher hs-CRP/HDL-C ratio was linked to worse long-term blood sugar, which in turn was linked to a greater burden of cardiometabolic disease. This aligns with biological evidence that chronic inflammation and unhealthy blood fats can worsen the body’s response to insulin, push blood sugar higher, and, over time, damage blood vessels and organs.

What this means for prevention and care

The authors conclude that the combined inflammation–cholesterol ratio is an independent warning signal for having several heart and metabolic diseases at once, and that long-term blood sugar control explains a substantial part of this risk. While the study’s cross-sectional design cannot prove cause and effect, it suggests that tackling three fronts together—inflammation, blood fats, and glucose—may be especially important for avoiding the dangerous cluster of high blood pressure, diabetes, heart disease, and stroke. If confirmed in future long-term studies, this simple ratio could help doctors spot high-risk individuals earlier and guide more targeted lifestyle and medical interventions to keep multiple cardiometabolic illnesses from piling up.

Citation: Chen, B., Han, L., Meng, T. et al. Associations of the hs-CRP/HDL-C ratio with cardiovascular metabolic multimorbidity: a large cross-sectional study. Sci Rep 16, 13371 (2026). https://doi.org/10.1038/s41598-026-43849-2

Keywords: cardiometabolic multimorbidity, chronic inflammation, good cholesterol, blood sugar control, heart and metabolic disease risk