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High sensitivity C-reactive protein in clinical practice
1Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
Insights
High sensitivity C-reactive protein (hs-CRP) effectively predicts cardiovascular disease risk, even in patients with low LDL cholesterol. hs-CRP should be used with lipid evaluation for comprehensive risk assessment.
Area of Science:
- Biochemistry
- Immunology
- Cardiology
Background:
- Atherosclerosis diagnosis in patients with low LDL cholesterol necessitates novel risk prediction markers.
- Inflammation markers, including cytokines, cell adhesion molecules, and acute phase reactants, are under investigation.
- High sensitivity C-reactive protein (hs-CRP) is an innate immune response protein with potential prognostic value.
Purpose of the Study:
- To evaluate the utility of hs-CRP in predicting cardiovascular risk across diverse patient populations.
- To determine the role of hs-CRP in conjunction with traditional risk factors like LDL cholesterol and metabolic syndrome.
Main Methods:
- Utilized high-sensitivity assays to measure hs-CRP levels.
- Correlated hs-CRP levels with cardiovascular risk stratification in apparently healthy individuals.
- Assessed hs-CRP performance across varying LDL cholesterol, Framingham Risk Score, and metabolic syndrome categories.
Main Results:
- hs-CRP levels predict future cardiovascular risk independently of LDL cholesterol and Framingham Risk Score.
- hs-CRP levels of <1 mg/L, 1-3 mg/L, and >3 mg/L correspond to low, moderate, and high cardiovascular risk, respectively.
- hs-CRP demonstrates prognostic value across all levels of metabolic syndrome.
Conclusions:
- hs-CRP is a valuable marker for global cardiovascular risk assessment, complementing lipid evaluations.
- Integrating hs-CRP into clinical practice can enhance risk stratification and guide preventive interventions.
- Improved cardiovascular risk knowledge may improve adherence to lifestyle and pharmacologic treatments for preventing cardiovascular events.
Abstract:
As a growing number of patients with low low-density lipoprotein cholesterol levels are diagnosed with atherosclerosis, research has shifted toward markers of inflammation in an attempt to improve global cardiovascular risk prediction. These markers include cytokines, cell adhesion molecules, and acute phase reactants like high sensitivity C-reactive protein, an innate immune response protein. When measured with new high-sensitivity assays, levels of high sensitivity C-reactive protein have proven to predict future cardiovascular risk at all levels of low-density lipoprotein cholesterol, at all levels of the Framingham Risk Score, and at all levels of the metabolic syndrome. Among apparently healthy men and women, levels of high sensitivity C-reactive protein of <1, 1-3, and >3 mg/L distinguish between those at low, moderate, and high risk for future cardiovascular disease, respectively. In clinical practice, high sensitivity C-reactive protein should be used along with lipid evaluation as part of global risk assessment. Improved knowledge of cardiovascular risk should lead to improved compliance with both lifestyle and pharmacologic interventions designed to prevent future cardiovascular events.
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