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The value of C-reactive protein in screening for future coronary heart disease events
David S Wald1, Anuradhani Kasturiratne, Jonathan P Bestwick
1Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, Charterhouse Square, London EC1M 6BQ, UK. d.s.wald@qmul.ac.uk
Insights
C-reactive protein (CRP) shows limited value for screening coronary heart disease (CHD). Analysis reveals poor detection rates, indicating CRP is not a reliable predictor for identifying individuals at risk of future CHD events.
Area of Science:
- Cardiology
- Biomarkers
- Preventive Medicine
Background:
- C-reactive protein (CRP) is an inflammatory marker linked to coronary heart disease (CHD).
- Previous studies suggested CRP's potential for screening future CHD events.
- Concerns exist regarding the overestimation of CRP's screening utility due to analytical methods.
Purpose of the Study:
- To critically evaluate the effectiveness of C-reactive protein (CRP) as a screening tool for predicting future coronary heart disease (CHD) events.
- To determine if CRP levels can reliably discriminate between individuals who will and will not experience a CHD event.
Main Methods:
- Analysis of relative frequency distributions of CRP levels from 22 prospective studies.
- Inclusion of individuals without prior cardiovascular disease who subsequently experienced CHD events and those who did not.
- Calculation of detection rate (sensitivity) at a specified false-positive rate.
Main Results:
- A detection rate of 18% was observed for a 10% false-positive rate at a CRP cut-off of 6.65 mg/L.
- The study indicates a significant overlap in CRP values between individuals who did and did not have CHD events.
- This overlap limits CRP's ability to effectively differentiate individuals at risk.
Conclusions:
- C-reactive protein (CRP) demonstrates poor performance as a screening test for future coronary heart disease (CHD).
- The substantial overlap in CRP levels between affected and unaffected individuals prevents its reliable use for risk discrimination.
- Current evidence suggests CRP is not a sufficiently effective biomarker for widespread CHD screening.
Abstract:
Measurement of C-reactive protein (CRP), an inflammatory marker associated with coronary heart disease (CHD) events, has been proposed as a means of screening for future CHD. In prospective studies about a three-fold increase in risk of CHD observed between the top fifth and bottom fifth of the CRP distribution has been taken to support the use of CRP as a screening test. This however gives an over-optimistic impression of its value, because people in the middle of the distribution, where most CHD events occur, are excluded from the analysis. A different analysis is needed to assess whether screening is worthwhile. Examination of the relative frequency distributions of CRP in individuals from 22 prospective studies of individuals without previous cardiovascular disease who subsequently did and did not have a CHD event shows that the detection rate (or sensitivity) was 18% for a false-positive rate of 10% (CRP cut-off 6.65 mg/L); a poor screening test. Whatever CRP cut-off is used, the overlap in CRP values between affected and unaffected individuals is too great for CRP to usefully discriminate between those who will and will not have a CHD event.
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