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Published on: January 28, 2020
Clinical significance of high-sensitivity C-reactive protein in cardiovascular disease
1Harvard Medical School, Center for Cardiovascular Disease Prevention, Department of Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue East, Boston, MA 02215, USA. conend@uhbs.ch
Insights
High-sensitivity C-reactive protein (CRP) is a strong predictor of cardiovascular events and Type 2 diabetes. Measuring hsCRP improves risk assessment, especially for intermediate-risk patients.
Area of Science:
- Cardiovascular Medicine
- Inflammation Biomarkers
- Risk Prediction
Background:
- Large cohort studies show high-sensitivity C-reactive protein (hsCRP) strongly predicts cardiovascular events, comparable to blood pressure and lipids.
- hsCRP also predicts Type 2 diabetes and modifies metabolic syndrome risk.
- hsCRP enhances risk classification when added to traditional risk factors, particularly for intermediate-risk individuals.
Purpose of the Study:
- To evaluate the clinical utility of hsCRP as a cardiovascular risk biomarker.
- To assess the impact of hsCRP on risk stratification and clinical outcomes.
Main Methods:
- Analysis of large-scale prospective cohort studies.
- Review of findings from statin trials regarding hsCRP levels and clinical outcomes.
- Examination of factors influencing hsCRP levels, including lifestyle modifications and medications.
Main Results:
- hsCRP is an independent predictor of cardiovascular events and Type 2 diabetes.
- Addition of hsCRP to traditional risk factors improves risk classification.
- Optimal outcomes in statin trials are associated with both low LDL cholesterol and low hsCRP levels.
- Lifestyle changes (diet, exercise, smoking cessation) and statins lower hsCRP.
Conclusions:
- hsCRP is a valuable biomarker for cardiovascular risk assessment and clinical care improvement.
- While causality is debated, hsCRP's predictive power is clinically significant.
- Further research is needed on whether hsCRP is a causal factor in atherosclerosis.
Abstract:
Large-scale prospective cohort studies consistently demonstrate a strong, independent relationship between high-sensitivity (hs) C-reactive protein (CRP) and incident cardiovascular events, with a magnitude of effect similar to, or larger than, that of blood pressure and lipid levels. As a biomarker of inflammation, hsCRP levels also predict incident Type 2 diabetes and modify the risk associated with the metabolic syndrome. Recent work further demonstrates that the addition of hsCRP to information provided by traditional risk factors improves risk classification, particularly for individuals otherwise considered to be at intermediate risk. Although there remains no direct evidence that lowering hsCRP lowers vascular risk, optimal clinical outcomes have been observed in statin trials among patients who not only reduced low-density lipoprotein cholesterol below 1.8 mmol/l (70 mg/dl), but who also reduced hsCRP below 2 mg/l. In addition to statins, CRP levels are lowered by diet, exercise and smoking cessation, all of which are known to lower vascular event rates. Whether or not CRP represents a causal agent in atherosclerosis is controversial and an area in need of further research. However, this controversy does not diminish the clinical utility of hsCRP as a biomarker of risk that, if appropriately used in clinical practice, can substantially improve clinical care.
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