Evolution of C-Reactive Protein as a Cardiac Risk Factor

Paula J. D'Amore, PhD, D(ABMLI)

Disclosures

Lab Med. 2005;36(4):234-238. 

In This Article

Association of CRP and CVD

There is now an enormous amount of evidence regarding CRP and CVD. Numerous studies established that hs-CRP measurements were able to predict first-time cardiovascular events.[15,16,17] High-sensitivity CRP was shown to be a much better predictor of risk than traditional risk markers such as the cholesterol/HDL ratio.[15] In large cohorts such as the Physician's Health Study (PHS) composed of healthy men[16] and the Women's Health Study (WHS) of healthy women,[15] hsCRP was found to be a predictor of risk for CVD. In a case study following long term monitoring of women in the WHS, hsCRP was a stronger predictor of CVD, independent of LDL levels.[18] In 2002, the AHA and the Centers for Disease Control and Prevention (CDC) held a workshop to determine which tests were most useful to assess cardiovascular risk. The AHA and CDC published a joint statement with their first ever recommendation for the measurement of CRP to aid in the diagnosis and treatment of cardiovascular diseases.[19] It was recommended that CRP levels be used to detect risk in patients who have a moderate risk of coronary heart disease. Three levels of hsCRP were defined corresponding to the distribution of CRP in an adult healthy population. Patients with hsCRP levels of <1 mg/L have a low CVD risk level, 1-3 mg/L are at an average risk, and those with a >3 mg/L level of hsCRP have a high risk of future cardiovascular disease. Levels exceeding 10 mg/L should be reevaluated for acute inflammatory conditions ( Table 1 ).

The AHA/CDC statement also recommended that in patients with stable coronary disease or acute coronary syndromes, hsCRP measurement may be useful as an independent marker of prognosis for recurrent events, including death, myocardial infarction and restenosis after percutaneous coronary intervention. High-sensitivity CRP was chosen as the inflammatory marker to be measured due to its ability to enhance the prediction of CVD beyond that of traditional risk factors.

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