Should high sensitive C-reactive protein measurement be included in health screening packages?

The Centers for Disease Control and Prevention (CDC) and the American Heart Association (AHA) have endorsed the optional use of high sensitive C-reactive protein (hsCRP) to identify patients without known coronary heart disease but who may be at higher absolute risk than estimated by major risk factors. This study assessed the potential value of hsCRP measurement in addition to routine lipid and risk factor assessment on patient management for individuals undergoing multiphasic health screening.

hsCRP was measured on fasting lipid samples on patients attending the Health Enrichment Clinic at Tan Tock Seng Hospital between January and April 2004. These results were then compared with the outcome of individual patient risk assessment (using the 2001 Singapore Ministry of Heath Clinical Practice Guidelines on Lipids), the patient's lipid results and whether the patient was already on anti-lipid treatment.

212 samples were analysed for hsCRP. Seven patients were already on anti-lipid drugs. Using the AHA/CDC guidelines, hsCRP measurement would be of value in deciding management in 12.7 percent of all patients. Of this group, 11 percent had hsCRP concentrations in the high risk category. Restricting hsCRP measurement to only those patients with two or more cardiac risk factors and not on anti-lipid drugs would increase the proportion of patients where hsCRP could be useful in deciding management, to 81.8 percent.

For clinicians prepared to consider treatment in patients with elevated hsCRP levels, hsCRP measurement should be included as part of health screening packages to selected patients based on individual cardiac risk assessment.