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High sensitivity C-reactive protein in cardiovascular risk assessment. CRP mania or useful screening?
A Sellmayer1, T Limmert, U Hoffmann
1Division of Cardiology, Medical Polyclinic, University Hospital of Munich, Munich, Germany. alois.sellmayer@medpoli.med.uni-muencnhen.de
Insights
Slightly elevated high-sensitivity C-reactive protein (hsCRP) indicates increased cardiovascular event risk, independent of cholesterol. Routine hsCRP testing for risk assessment is not yet recommended due to accuracy limitations.
Area of Science:
- Biochemistry
- Cardiology
- Clinical Chemistry
Background:
- C-reactive protein (CRP) is an acute phase reactant and sensitive marker of inflammation.
- High-sensitivity CRP (hsCRP) assays reveal that subtly elevated levels, within conventional normal ranges, predict cardiovascular disease risk.
Purpose of the Study:
- To investigate the association between hsCRP levels and cardiovascular event risk.
- To evaluate the predictive value of hsCRP in apparently healthy individuals.
- To assess the impact of statin therapy on hsCRP levels.
Main Methods:
- Analysis of large-scale prospective trials, including the Physicians' Health Study and Women's Health Study.
- Assessment of hsCRP levels in relation to cardiovascular events like myocardial infarction, peripheral artery disease, and carotid artery disease.
- Review of the effect of HMG-CoA reductase inhibitors (statins) on hsCRP levels.
Main Results:
- Slightly increased baseline hsCRP levels in healthy individuals are associated with a twofold higher risk of future myocardial infarction.
- hsCRP's predictive value for cardiovascular events is independent of traditional risk factors, including serum cholesterol.
- Elevated hsCRP levels correlate with increased risk for peripheral artery disease and faster progression of carotid artery disease.
- Statins are the only medication found to consistently reduce hsCRP levels, albeit by approximately 15%.
Conclusions:
- Elevated hsCRP is a significant, independent predictor of cardiovascular events.
- Current limitations in accuracy and lack of defined cut-off points preclude routine hsCRP measurement for cardiovascular risk assessment.
- hsCRP remains a promising, yet not fully established, potential biomarker for cardiovascular disease risk.
Abstract:
Elevated level of the acute phase reactant C-reactive protein (CRP) is a very sensitive marker of acute inflammatory reactions. Using high sensitivity assays for CRP, recent observations indicate that slightly elevated CRP levels which would be in the normal range of conventional assays are a novel marker for an increased risk for cardiovascular events, especially coronary artery disease and myocardial infarction. Various large scale prospective trials including the Physicians' Health Study and the Women's Health Study revealed that slightly increased hsCRP levels at base line in apparently healthy persons are associated with a 2-fold increase in the risk of a future myocardial infarction. The predictive value of hsCRP was found to be independent from classic risk factors, in particular from elevated serum cholesterol. An increase in hsCRP levels was also associated with a higher risk to develop peripheral artery disease and with a faster progression of carotid artery disease. Until now, treatment with HMG-CoA reductase inhibitors (statins) has been found to be the only medication to consistently decrease hsCRP levels, although by about 15% only. Despite the association of elevated hsCRP levels with future cardiovascular events, routine measurement of hsCRP for cardiovascular risk assessment is currently not recommended because of its low accuracy, the lack of a clear cut-off point for elevated hsCRP levels and the lack of an absolute predictive value. So far, hsCRP remains an interesting potential risk marker for cardiovascular disease whose definite relevance remains to be established.