What is the meaning of elevated C-reactive protein (CRP) in cardiac conditions?

From the Guidelines

Elevated C-reactive protein (CRP) levels in cardiac conditions indicate increased inflammation, suggesting a higher risk of cardiovascular problems, and should be addressed through lifestyle changes and medical management to reduce cardiovascular risk.

Understanding CRP

CRP is produced by the liver in response to inflammation, with normal levels generally below 3 mg/L. In cardiac contexts, levels above 3 mg/L are considered elevated, with higher levels indicating greater risk:

• 3-10 mg/L: Moderate risk

• 10 mg/L: High risk

Recommendations for Elevated CRP

If your CRP is elevated:

1. Consult your doctor for a full evaluation
2. Consider lifestyle changes:
   • Quit smoking
   • Exercise regularly (30 minutes daily)
   • Maintain a healthy diet rich in fruits, vegetables, and whole grains
   • Manage stress
3. Your doctor may recommend:
   • Statins (e.g., atorvastatin 10-80 mg daily) 1
   • Aspirin (75-325 mg daily)
   • Further cardiac testing (e.g., stress test, coronary calcium scan) Elevated CRP doesn't necessarily mean you have heart disease, but it suggests increased inflammation that could contribute to atherosclerosis and heart problems. Addressing this early through lifestyle changes and medical management can help reduce your cardiovascular risk, as supported by studies such as those published in Circulation 1.

Key Considerations

• The measurement of hs-CRP may be useful as an independent marker for assessing likelihood of recurrent events, including death, myocardial infarction, or restenosis after percutaneous coronary intervention 1.
• Secondary preventive interventions with proven efficacy should not be dependent on hs-CRP levels 1.
• Serial testing of hs-CRP should not be used to monitor effects of treatment 1.

From the Research

Elevated C-Reactive Protein (CRP) in Cardiac Conditions

Elevated C-reactive protein (CRP) levels are associated with increased cardiovascular risk, including coronary heart disease, myocardial infarction, and peripheral artery disease 2, 3, 4, 5, 6. The clinical significance of elevated CRP levels includes:

• Identification of high-risk individuals for cardiovascular events 2, 3, 5
• A gauge to monitor the activity of the disease 2
• A potential therapeutic target to alter the inflammatory component of the disease process 2

Association with Cardiovascular Risk

Elevated CRP levels are directly involved in atherogenesis and are associated with increased cardiovascular risk 3, 4, 5. The predictive value of CRP is independent of classic risk factors, such as elevated serum cholesterol 3.

Measurement and Interpretation

High-sensitivity CRP measurements are standardized and reproducible 2. However, routine measurement of CRP for cardiovascular risk assessment is not currently recommended due to its low accuracy and lack of a clear cut-off point for elevated CRP levels 3.

Treatment and Reduction of CRP Levels

Treatment with HMG-CoA reductase inhibitors (statins) has been found to consistently decrease CRP levels, although by only about 15% 3. Bezafibrate did not reduce CRP levels compared to placebo in patients with chronic coronary heart disease 6.

Prognostic Value

Elevated CRP levels are associated with increased risk of myocardial infarction, total death, and cardiac death in patients with chronic coronary heart disease 6. High CRP responses after acute myocardial infarction indicate an unfavorable outcome, even after correction for other risk factors 5.