Related Experiment Video
Updated: May 25, 2026
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
High-sensitive C-reactive protein: universal prognostic and causative biomarker in heart disease?
Ernst Rietzschel1, Marc De Buyzere
1Department of Cardiology, University Hospital Ghent, Belgium. errietzschel@yahoo.com
Insights
C-reactive protein (CRP) is linked to cardiovascular events, but evidence suggests it is not causative. High-sensitivity CRP assays show a significant association with major cardiovascular events and mortality.
Area of Science:
- Biochemistry
- Cardiology
- Epidemiology
Background:
- C-reactive protein (CRP) is a key marker for acute phase reactions.
- Experimental data suggests CRP's potential role in all stages of atherosclerosis, from endothelial dysfunction to atherothrombotic events.
- Conflicting evidence exists regarding CRP's causality in atherosclerosis, with Mendelian randomization studies questioning its direct role.
Purpose of the Study:
- To evaluate the association between high-sensitivity C-reactive protein (hs-CRP) levels and cardiovascular events.
- To assess the predictive value of hs-CRP for all-cause and cancer mortality.
- To examine the clinical utility of incorporating hs-CRP into cardiovascular risk assessment.
Main Methods:
- Meta-analyses were conducted to determine the risk associated with hs-CRP levels for major cardiovascular events.
- Adjustments were made for classical and metabolic risk factors.
- The predictive performance of hs-CRP was evaluated for mortality outcomes and its impact on risk stratification tools.
Main Results:
- A one standard deviation increase in hs-CRP was associated with a 1.5-1.7 fold increased risk of major cardiovascular events after adjusting for classical risk factors.
- Further adjustments for metabolic factors reduced this risk to 1.2-1.4 fold, remaining significant.
- hs-CRP also demonstrated predictive value for all-cause and cancer mortality.
- The addition of hs-CRP to existing risk charts and biomarker panels yielded minor and inconsistent improvements in risk prediction.
Conclusions:
- While hs-CRP is significantly associated with cardiovascular events and mortality, evidence does not support a direct causative role.
- The clinical benefit of using hs-CRP for guiding treatment decisions, such as statin therapy in primary prevention, requires further investigation.
- hs-CRP's incremental value in cardiovascular risk prediction beyond established risk factors is limited.
Abstract:
C-reactive protein (CRP), a pentraxin protein, is an established marker of acute phase reactions. There is some experimental evidence that the CRP molecule could be causative in all stages of atherosclerotic disease starting from endothelial dysfunction, continuing to plaque formation and destabilization, and to atherothrombotic complications. However, each claim of causality has elicited a counterpoint argument, and Mendelian randomization studies have confidently shown that the concentration of CRP is unlikely to be causative. Meta-analyses have attributed a 1.5-1.7-fold risk to one standard deviation increase of high-sensitive CRP (a high-sensitivity CRP assay) for major cardiovascular events after adjustments for classical risk factors. Additional adjustments for metabolic factors reduced the risk to approximately 1.2-1.4-fold, which is still significant. Of interest, high-sensitive CRP also predicted all-cause and cancer mortality. Driven by the JUPITER trial that showed a benefit on outcome for treatment with rosuvastatin in primary prevention, treatment has been recommended in patients with a moderate Framingham Risk Score with a high-sensitive CRP of >2 mg/l. However, adding CRP to risk charts and biomarker panels mostly yielded small and inconsistent improvements.
Related Concept Videos
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:30Coronary Artery Disease I: Introduction
01:30Acute Coronary Syndrome I: Introduction