From the Guidelines
These lab values indicate a high risk of atherosclerotic cardiovascular disease (ASCVD) and require prompt medical attention. The alkaline phosphatase (ALP) level of 180 is elevated above the normal range, suggesting possible liver or bone disease. The high-sensitivity C-reactive protein (hsCRP) of 12.6 is significantly elevated, indicating substantial inflammation in the body, which is a risk-enhancing factor for ASCVD, as stated in the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 1.
- Key points to consider:
- Elevated hsCRP levels above 2.0 mg/L are associated with increased ASCVD risk, and a level of 12.6 mg/L is substantially elevated, indicating a high level of inflammation.
- The combination of elevated ALP and hsCRP suggests an active inflammatory process that may be contributing to the patient's risk of ASCVD.
- According to the guideline, conditions associated with systemic inflammation, such as elevated hsCRP, appear to predispose to atherothrombotic events, which reasonably justifies statin therapy in intermediate-risk patients 1. You should contact your healthcare provider immediately for further evaluation and consideration of statin therapy, as these results could indicate a high risk of ASCVD. Additional testing will likely be needed, including comprehensive liver function tests, complete blood count, and possibly imaging studies, to determine the underlying cause of the elevated ALP and hsCRP levels. Do not attempt to self-treat these abnormalities. Your doctor will need to evaluate these results in the context of your symptoms, medical history, and physical examination to determine the appropriate treatment.
From the Research
Alkaline Phosphatase and C-Reactive Protein Levels
- The provided alkaline phosphatase (ALP) level is 180, and the C-reactive protein (CRP) level is 12.6.
- According to the study 2, higher serum total ALP levels are associated with increased serum CRP levels and mortality in the general and CKD populations.
- However, the same study found that skeletal AP was not associated with elevated CRP or mortality, whereas nonskeletal AP was associated with elevated CRP and mortality in non-CKD populations.
Association between ALP and CRP
- A study 3 found a significant correlation between plasma ALP and CRP levels in a Hong Kong Chinese population, particularly in women.
- Another study 4 found that serum ALP level was positively and independently associated with inflammatory markers, including CRP, in adults aged 60 years or older.
- The study 5 also found that log ALP was an independent predictor of log CRP in a multivariate analysis.
Clinical Implications
- Elevated serum ALP has been associated with peripheral arterial disease (PAD) 6 and cardiometabolic risk 5.
- The association between ALP and CRP suggests that ALP may be a marker of systemic inflammation, particularly in women 3.
- However, the clinical significance of the association between ALP and CRP in the context of the provided laboratory values is unclear and requires further evaluation.