Evaluation of C-reactive protein in primary and secondary prevention

Inflammation is pivotal in atherosclerosis, and C-reactive protein (CRP) is an inflammatory marker that predicts cardiovascular events. Several population-based studies have demonstrated that baseline CRP levels predict future cardiovascular events. CRP testing may thus have a major adjunctive role in the global assessment of cardiovascular risk. Recently, the National Cholesterol Education Program, through the Adult Treatment Panel III guidelines, identified CRP and another marker of inflammation, the fibrinogen, as "emerging risk factors," suggesting that their measurement may improve the estimations of absolute risk obtained using the traditional cardiovascular risk factors. In terms of clinical application, CRP seems to be a strong predictor of cardiovascular events such as low-density lipoprotein cholesterol and adds prognostic information to all levels of calculated Framingham Risk Score and to the cluster of risk factors of metabolic syndrome. Several pharmacologic agents proven to reduce vascular risk also reduce CRP levels. Among these, all statins lower CRP, with more potent statins having greater effects; on average, median CRP levels decline from 15 to 25% after 6 weeks of starting therapy. Although limitations concerning the inflammatory screening remain, available data suggest that CRP has the potential to play an important role in adding more information for the evaluation of global risk assessment in primary prevention of cardiovascular disease.