High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of
1Center for Cardiovascular Disease Prevention, Divisions of Cardiovascular Diseases and Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02214, USA. pridker@partners.org
Insights
High-sensitivity C-reactive protein (HSCRP) effectively identifies individuals at high risk for myocardial infarction and stroke. Measuring HSCRP can improve cardiovascular disease risk prediction and guide primary prevention therapies.
Area of Science:
- Cardiovascular Medicine
- Inflammation Biology
- Preventive Cardiology
Background:
- Atherothrombosis is significantly influenced by inflammation.
- Inflammatory markers, like high-sensitivity C-reactive protein (HSCRP), offer potential for identifying individuals at risk of plaque rupture.
Purpose of the Study:
- To evaluate the role of HSCRP in predicting cardiovascular events.
- To assess HSCRP's utility in enhancing global cardiovascular risk prediction.
- To explore HSCRP's potential in guiding primary prevention strategies.
Main Methods:
- Analysis of large-scale prospective studies.
- Evaluation of HSCRP as a predictor of myocardial infarction and stroke.
- Comparison of HSCRP screening with standard lipid screening.
- Development of risk prediction algorithms for outpatient use.
Main Results:
- HSCRP is a strong, independent predictor of future myocardial infarction and stroke in apparently healthy individuals.
- Adding HSCRP to standard lipid screening improves global risk prediction across various cholesterol levels.
- Commercial HSCRP assays are available, demonstrating comparable accuracy to cholesterol screening.
Conclusions:
- HSCRP shows potential as an adjunct for global risk assessment in cardiovascular disease primary prevention.
- HSCRP may help target therapies like aspirin and statins for primary prevention.
- Despite limitations, HSCRP offers a valuable tool for identifying at-risk individuals.
Abstract:
Inflammation plays a major role in atherothrombosis, and measurement of inflammatory markers such as high-sensitivity C-reactive protein (HSCRP) may provide a novel method for detecting individuals at high risk of plaque rupture. Several large-scale prospective studies demonstrate that HSCRP is a strong independent predictor of future myocardial infarction and stroke among apparently healthy men and women and that the addition of HSCRP to standard lipid screening may improve global risk prediction among those with high as well as low cholesterol levels. Because agents such as aspirin and statins seem to attenuate inflammatory risk, HSCRP may also have utility in targeting proven therapies for primary prevention. Inexpensive commercial assays for HSCRP are now available; they have shown variability and classification accuracy similar to that of cholesterol screening. Risk prediction algorithms using a simple quintile approach to HSCRP evaluation have been developed for outpatient use. Thus, although limitations inherent to inflammatory screening remain, available data suggest that HSCRP has the potential to play an important role as an adjunct for global risk assessment in the primary prevention of cardiovascular disease.
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