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Comparison of High-Sensitivity C-Reactive Protein vs C-reactive Protein for Cardiovascular Risk Prediction in Chronic
Emilie Han1, Monika Fritzer-Szekeres2, Thomas Szekeres2
1Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria.
Insights
Standard C-reactive protein (CRP) tests can accurately assess cardiovascular disease risk, mirroring high-sensitivity CRP (hs-CRP) results. This finding suggests routine CRP measurements may replace more expensive hs-CRP tests for inflammation assessment.
Area of Science:
- Biomarkers and Inflammation
- Cardiovascular Disease Risk Assessment
Background:
- High-sensitivity C-reactive protein (hs-CRP) is a key biomarker for predicting cardiovascular disease risk by detecting low-grade inflammation.
- Recent advancements have increased the sensitivity of regular C-reactive protein (CRP) measurements, with lower detection limits.
Purpose of the Study:
- To compare the diagnostic accuracy of regular CRP tests with hs-CRP.
- To explore the association between CRP and hs-CRP in cardiovascular risk assessment.
Main Methods:
- Retrospective analysis of hs-CRP data from 570 patients undergoing cardiovascular risk assessment.
- Correlation analysis using kappa statistic, Bland-Altman plots, and Spearman regression.
- Cox regression and Kaplan-Meier curves to assess the association with cardiovascular events.
Main Results:
- A high agreement (91.4%, kappa 0.87) was observed between CRP and hs-CRP risk classifications, with only 8.6% reclassification.
- Strong correlation (Spearman R2 = 0.98, P < 0.001) and minimal average difference (0.19 mg/L) between CRP and hs-CRP measurements.
- Elevated CRP or hs-CRP levels (>3 mg/L) were associated with increased cardiovascular events, alongside older age and history of coronary artery disease.
Conclusions:
- Routine CRP measurements in the lower range show high correlation with hs-CRP.
- Standard CRP tests can effectively replace more costly hs-CRP assays for cardiovascular risk stratification.
- This offers a cost-effective approach to inflammation assessment in clinical practice.
Background:
High-sensitivity C-reactive protein (hs-CRP) is a biomarker used for risk prediction for cardiovascular disease by assessing low concentration of inflammation. Measurements of regular CRP have become very sensitive with a lower detection limit of 0.3 mg/L. This study aimed to compare and explore the association between CRP and hs-CRP.
Methods:
Data from 607 consecutive patients referred for cardiovascular risk assessment with hs-CRP were reviewed retrospectively. In total, 570 patients were included in the analysis and classified into 3 (low-, medium-, and high-risk) groups (hs-CRP cutoff: <1, 1-3, >3 mg/L). Correlation between hs-CRP and CRP was assessed with the kappa statistic and visualized with a Bland-Altman plot. The association between hs-CRP and occurrence of the composite outcome (acute myocardial infarction, stroke, coronary intervention [percutaneous coronary intervention or bypass surgery], or death) was determined with Cox regression analysis and visualized with Kaplan-Meier curves.
Results:
A total number reclassification occurred in 8.6% of the cases for CRP risk groups, which demonstrates an agreement of 91.4% (kappa 0.87; P < 0.001). The correlation between CRP and hs-CRP was significant (P < 0.001), Spearman regression R2 = 0.98. A Bland-Altman plot displayed an average difference of 0.19 mg/L (95%CI, 0.17 to 0.23) between the CRP and hs-CRP. Cardiovascular events were more likely to occur in patients who were older, with hs-CRP or CRP >3 mg/L and a history of coronary artery disease.
Conclusions:
The usual laboratory tests for CRP values in the lower range highly correlate with the hs-CRP tests and can therefore replace the costlier hs-CRP measurements.
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