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C-reactive protein and coronary heart disease: diagnostic and therapeutic implications for primary prevention
1Department of Laboratory Medicine, Children's Hospital and Harvard Medical School, Boston MA 02115, USA. Rifai@tch.harvard.edu
Insights
C-reactive protein (CRP) indicates inflammation and predicts coronary heart disease (CHD) risk independently. High-sensitivity CRP (hs-CRP) assays are crucial for risk assessment and guiding potential treatments like statins and aspirin.
Area of Science:
- Cardiology
- Inflammation Research
- Biomarker Discovery
Background:
- Coronary heart disease (CHD) is a leading cause of mortality globally.
- Inflammation is recognized as a key factor in atherosclerosis development and progression.
- C-reactive protein (CRP) is an acute-phase reactant linked to systemic and vascular inflammation.
Purpose of the Study:
- To evaluate the role of C-reactive protein (CRP) as a predictor of cardiovascular events.
- To highlight the necessity of high-sensitivity CRP (hs-CRP) assays for accurate risk assessment.
- To explore the potential for hs-CRP in risk stratification algorithms and therapeutic strategies.
Main Methods:
- Review of laboratory and clinical studies investigating CRP and cardiovascular events.
- Emphasis on the use of high-sensitivity assays (hs-CRP) for CRP measurement.
- Discussion of risk stratification algorithms incorporating hs-CRP and lipid ratios.
Main Results:
- CRP levels predict future cardiovascular events independently of traditional risk factors.
- hs-CRP measurement is essential for accurate risk prediction in asymptomatic individuals.
- Statin therapy and aspirin may mitigate CHD risk in individuals with elevated hs-CRP.
Conclusions:
- hs-CRP is a valuable independent predictor of coronary heart disease risk.
- Standardization of hs-CRP assays is critical for clinical application and risk stratification.
- Further research is ongoing to develop clinical utilities and therapeutic strategies targeting hs-CRP.
Abstract:
Coronary heart disease (CHD) is the leading cause of death in the industrialized world. Recent laboratory and clinical studies have shown that inflammation plays a pivotal role in the inception, progression, and destabilization of atheromas. The acute-phase reactant C-reactive protein (CRP) has been shown to reflect systemic and, perhaps, vascular inflammation and to predict future cardiovascular events in asymptomatic individuals. The relative risk associated with CRP is independent of other cardiovascular disease risk factors. High-sensitivity assays (hs-CRP) are needed for the measurement of CRP concentration for the purpose of predicting the risk of future coronary events. Available assays must be standardized because patients' results will be interpreted using population-based cutpoints. An algorithm for risk stratification incorporating hs-CRP and total cholesterol to high-density lipoprotein cholesterol ratio has been developed. Statin class drugs and aspirin appear to modulate CHD risk in those with increased hs-CRP concentration. Several prospective studies are now underway to specifically develop novel clinical utilities and therapeutic strategies for hs-CRP.