High-sensitivity C-reactive protein and cardiovascular disease: a resolute belief or an elusive link?

Area of Science:

• Cardiovascular Medicine
• Inflammation Biology
• Biomarker Research

Background:

• Inflammation is integral to atherosclerosis and cardiovascular (CV) event risk.
• High-sensitivity C-reactive protein (hsCRP) is a prominent inflammatory biomarker studied for CV risk assessment.
• While associated with CV disease (CVD) risk, hsCRP's causative role in atherothrombosis is not definitively established by randomized trials.

Purpose of the Study:

• To review the current understanding and clinical application of hsCRP in cardiovascular medicine.
• To evaluate hsCRP's biological role, epidemiological associations, biomarker quality, and utility in guiding statin therapy.
• To clarify the debate surrounding hsCRP's incremental predictive value beyond conventional risk factors.

Main Methods:

• Literature review of hsCRP's biology, epidemiology, and clinical utility.
• Analysis of hsCRP's role in atherosclerosis and association with cardiovascular disease (CVD).
• Examination of hsCRP as a risk biomarker and its application in statin therapy decisions.

Main Results:

• hsCRP is implicated in vascular remodeling and plaque development, correlating with increased CVD risk.
• Evidence for hsCRP as a causative factor in atherothrombosis is limited.
• The incremental predictive value of hsCRP in risk stratification beyond traditional factors is debated.

Conclusions:

• Despite guidelines, consensus on optimal hsCRP use in clinical practice, particularly for primary prevention and statin therapy, is lacking.
• Further understanding of hsCRP's role is needed to guide treatment decisions effectively.
• The clinical utility of hsCRP for risk prediction and therapy guidance requires careful consideration.