What is the significance of elevated High Sensitivity C-Reactive Protein (hs CRP)?

From the Guidelines

High-sensitivity C-reactive protein (hsCRP) should be used at the discretion of the physician in patients judged to be at intermediate risk for cardiovascular disease, as it may help direct further evaluation and therapy in the primary prevention of CVD. According to the CDC/AHA workshop on markers of inflammation and cardiovascular disease 1, hsCRP is an independent marker of risk that can be used to assess cardiovascular risk in adults without known CVD. The study recommends that hsCRP may be useful in motivating patients to improve their lifestyle behaviors, although the benefits of this strategy remain uncertain. Some key points to consider when using hsCRP include:

• hsCRP levels may be useful in evaluating heart disease risk in people with intermediate risk factors
• Normal hsCRP levels are generally below 3.0 mg/L, with levels below 1.0 mg/L indicating low cardiovascular risk, 1.0-3.0 mg/L indicating moderate risk, and above 3.0 mg/L suggesting high risk
• hsCRP levels can be temporarily elevated due to infections, injuries, or other inflammatory conditions, so results should be interpreted alongside other risk factors and possibly repeated if initially high
• Lifestyle changes like exercise, weight loss, smoking cessation, and medications like statins can help lower hsCRP levels and reduce cardiovascular risk. It's also important to note that serial testing of hsCRP should not be used to monitor the effects of treatment, and application of secondary prevention measures should not depend on hsCRP determination 1.

From the FDA Drug Label

The JUPITER study was stopped early by the Data Safety Monitoring Board due to meeting predefined stopping rules for efficacy in rosuvastatin-treated subjects ... Patients had a median baseline LDL-C of 108 mg/dL and hsCRP of 4.3 mg/L. At one year, rosuvastatin increased HDL-C and reduced LDL-C, hsCRP, total cholesterol and serum triglyceride levels (p<0.001 for all versus placebo).

• hsCRP levels: The study population had hsCRP levels ≥2 mg/L, with a median baseline hsCRP of 4.3 mg/L.
• Effect of rosuvastatin on hsCRP: Rosuvastatin reduced hsCRP levels at one year (p<0.001 versus placebo) 2.

From the Research

Hs-CRP and Cardiovascular Risk

• Hs-CRP is a marker of systemic inflammation and a mediator of atherothrombotic disease, with levels correlating with cardiovascular disease risk 3
• Elevated hs-CRP levels are associated with high risk for cardiovascular events, and statins have been found to reduce hs-CRP levels 4, 3
• The JUPITER trial proved the benefit of statins in cardiovascular risk reduction in patients with low grades of systemic inflammation and 'normal' cholesterol levels 5

Hs-CRP Reduction with Statin Therapy

• Atorvastatin 80 mg reduces hs-CRP levels to a greater extent than simvastatin 40 mg 6
• High-dose rosuvastatin and atorvastatin are effective in reducing hs-CRP levels, but atorvastatin may have a better safety profile and be more cost-effective 7
• Quadruple-dose rosuvastatin and rosuvastatin combined with ezetimibe have similar anti-inflammatory effects, but high-density lipoprotein cholesterol (HDL-C) is significantly improved with quadruple-dose rosuvastatin 4

Hs-CRP Levels in Different Populations

• The mean hs-CRP value in the Indian population is higher than in Western populations, with a value of 1.88 mg/l derived from control arms of case-control studies 5
• Further large prospective cohort studies with longer term follow-ups are essential to integrate hs-CRP into risk prediction models for cardiovascular disease prevention in different populations 5