C-reative protein cardiovascular disease risk

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http://www.americanheart.org/presenter.jhtml?identifier=4648

Inflammation, Heart Disease and Stroke: The Role of C-Reactive

Protein

How does inflammation relate to heart disease and stroke risk?

" Inflammation " is the process by which the body responds to injury.

Laboratory evidence and findings from clinical and population

studies suggest that inflammation is important in atherosclerosis

(ath " er-o-skleh-RO'sis). This is the process in which fatty deposits

build up in the lining of arteries.

C-reactive protein (CRP) is one of the acute phase proteins that

increase during systemic inflammation. It's been suggested that

testing CRP levels in the blood may be a new way to assess

cardiovascular disease risk. A high sensitivity assay for CRP test

(hs-CRP) is now widely available.

The American Association and the Centers for Disease Control and

Prevention recently published a joint scientific statement about

using inflammatory markers in clinical and public health practice.

This statement was developed after systematically reviewing the

evidence of association between inflammatory markers (mainly CRP)

and coronary heart disease and stroke.

What's the role of CRP in predicting recurrent cardiovascular and

stroke events?

A growing number of studies have examined whether hs-CRP can predict

recurrent cardiovascular disease and stroke and death in different

settings. High levels of hs-CRP consistently predict new coronary

events in patients with unstable angina and acute myocardial

infarction (heart attack). Higher hs-CRP levels also are associated

with lower survival rate of these people. Many studies suggested

that after adjusting for other prognostic factors, hs-CRP was still

useful as a risk predictor.

Recent studies also suggest that higher levels of hs-CRP may

increase the risk that an artery will reclose after it's been opened

by balloon angioplasty. High levels of hs-CRP in the blood seem to

predict prognosis and recurrent events in patients with stroke and

peripheral arterial disease.

What's the role of hs-CRP in predicting new cardiovascular events?

Most studies show that the higher the hs-CRP levels, the higher the

risk of developing heart attack. In fact, scientific studies have

found that the risk for heart attack in people in the upper third of

hs-CRP levels is twice that of those whose hs-CRP is in the lower

third. These prospective studies include men, women and the elderly.

Recent studies also found an association between sudden cardiac

death, peripheral arterial disease and hs-CRP. However not all of

the established cardiovascular risk factors were controlled for when

the association was examined. The true independent association

between hs-CRP and new cardiovascular events hasn't yet been

established.

What causes low-grade inflammation?

No one knows for sure what causes the low-grade inflammation that

seems to put otherwise healthy people at risk. However, the new

findings are consistent with the hypothesis that an infection --

possibly one caused by a bacteria or a virus -- might contribute to

or even cause atherosclerosis.

Possible infectious bacteria include Chlamydia pneumoniae (klah-

MID'e-ah nu-MO'ne-i) and Helicobacter pylori (HEL'ih-ko-bak " ter pi-

LO'ri). Possible viral agents include herpes simplex virus and

cytomegalovirus (si " to-meg " ah-lo-VI'rus). Thus, it may be that

antimicrobial or antiviral therapies will someday join other

therapies used to prevent heart attacks.

This idea clearly needs to be tested in clinical trials. However,

the notion that chronic infection can lead to unsuspected disease

isn't foreign to most doctors. For example, bacterial infection with

Helicobacter pylori is now known to be the major cause of stomach

ulcers. The treatment for this condition now routinely includes

antibiotic therapy. Patients with autoimmune diseases and cancer

also often have elevated CRP levels.

Should I have my CRP level measured?

If a person's cardiovascular risk score — judged by global risk

assessment — is low (the possibility of developing cardiovascular

disease is less than 10 percent in 10 years, no test is immediately

warranted. If the risk score is in the intermediate range (10-20

percent in 10 years), such a test can help predict a cardiovascular

and stroke event and help direct further evaluation and therapy.

However, the benefits of such therapy based on this strategy remain

uncertain. A person with a high risk score (greater than 20 percent

in 10 years) or established heart disease or stroke should be

treated intensively regardless of hs-CRP levels.

What is the normal range of hs-CRP level?

If hs-CRP level is lower than 1.0 mg/L, a person has a low risk of

developing cardiovascular disease.

If hs-CRP is between 1.0 and 3.0 mg/L, a person has an average risk.

If hs-CRP is higher than 3.0 mg/L, a person is at high risk.

If, after repeated testing, patients have persistently unexplained,

markedly elevated hs-CRP (greater than 10.0 mg/L), other evaluation

should be considered to exclude noncardiovascular causes.

Related AHA publications:

Heart and Stroke Facts

Know the Facts, Get the Stats

Controlling Your Risk Factors... heart attack and stroke

Six Steps to a Healthier Heart

Aspirin and Your Health