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High-sensitivity C-reactive protein and cardiovascular risk: rationale for screening and primary prevention
1Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA. pridker@partners.org
Insights
High-sensitivity C-reactive protein (hs-CRP) is a stronger predictor of cardiovascular disease risk than LDL cholesterol, even in healthy individuals. Screening for hs-CRP may improve primary prevention strategies.
Area of Science:
- Cardiovascular Medicine
- Inflammation Research
- Preventive Cardiology
Background:
- Systemic inflammation, indicated by high-sensitivity C-reactive protein (hs-CRP), is a key factor in atherothrombotic disease.
- hs-CRP levels correlate with cardiovascular disease (CVD) risk and mediate atherothrombotic processes.
- Previous studies suggest hs-CRP's role in assessing CVD risk.
Purpose of the Study:
- To evaluate high-sensitivity C-reactive protein (hs-CRP) as a predictor of cardiovascular disease risk in healthy women.
- To determine if hs-CRP provides additional prognostic information beyond traditional risk factors like LDL cholesterol and metabolic syndrome.
- To explore the potential benefit of statin therapy in individuals with elevated hs-CRP levels.
Main Methods:
- Analysis of data from the Women's Health Study, including 27,939 healthy women.
- Comparison of hs-CRP as a risk predictor against low-density lipoprotein (LDL) cholesterol.
- Assessment of hs-CRP's incremental prognostic value in risk scoring and metabolic syndrome diagnosis.
Main Results:
- hs-CRP was found to be a stronger predictor of cardiovascular risk than LDL cholesterol.
- Elevated hs-CRP predicted increased risk even in individuals without overt hyperlipidemia.
- hs-CRP provided additional prognostic information to existing risk stratification methods and metabolic syndrome diagnosis.
Conclusions:
- hs-CRP is a valuable marker for cardiovascular disease risk assessment in primary prevention populations.
- Screening for hs-CRP may enhance the identification of at-risk individuals.
- Statins may offer greater cardiovascular benefits to individuals with elevated hs-CRP levels, warranting further investigation in trials like JUPITER.
Abstract:
Inflammation is a major factor in atherothrombotic disease. Levels of high-sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation and a mediator of atherothrombotic disease, have been shown to correlate with cardiovascular disease risk. Recent findings in 27,939 healthy women in the Women's Health Study indicate that hs-CRP (1) is a stronger predictor of risk than low-density lipoprotein (LDL) cholesterol, (2) predicts elevated risk in subjects without overt hyperlipidemia, and (3) adds prognostic information to risk scoring and LDL cholesterol categories. Other data from this cohort show that hs-CRP level adds prognostic information to the diagnosis of the metabolic syndrome. Taken together with other data in men on the association of hs-CRP with vascular risk, a strong argument is provided for screening in the primary prevention population. With regard to potential treatment, statins have been found to reduce hs-CRP levels, and data from statin treatment trials raise the possibility that subjects with elevated hs-CRP levels may derive greater benefit from treatment than do patients without elevated hs-CRP. The Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) trial is planned to examine the effects of rosuvastatin treatment in preventing cardiovascular events in 15,000 healthy subjects with elevated hs-CRP levels in the absence of overt hyperlipidemia.
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