Low Inflammation Markers and Health Status
Low inflammation markers generally indicate better health status, but they are not a definitive indicator of overall health and should be interpreted within the broader clinical context of the individual.
Understanding Inflammatory Markers
C-Reactive Protein (hsCRP)
- The American Heart Association and Centers for Disease Control recommend using high-sensitivity C-reactive protein (hsCRP) as the preferred inflammatory marker for cardiovascular risk assessment 1
- Risk categories for hsCRP are standardized as:
- Individuals in the low-risk category have approximately half the relative risk of cardiovascular events compared to those in the high-risk category 2
Other Inflammatory Markers
- Fibrinogen, serum amyloid A, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) are also used as inflammatory markers but have less standardization and clinical validation than hsCRP 1, 3
- White blood cell count is a simple, widely available marker of inflammation associated with cardiovascular risk 1
Relationship Between Low Inflammatory Markers and Health
Cardiovascular Health
- Low levels of inflammatory markers, particularly hsCRP, are associated with reduced risk of cardiovascular events 2, 4
- In women, those with the lowest quartile of hsCRP had significantly lower risk of cardiovascular events compared to those in the highest quartile (relative risk 4.4) 4
Overall Health Status
- Low-grade inflammation is associated with numerous chronic conditions including cancer, chronic obstructive pulmonary disease, type-2 diabetes, obesity, peripheral/coronary artery disease, and autoimmune diseases 3
- Higher adherence to healthy lifestyle behaviors (diet, physical activity, not smoking, social support, and adequate sleep) is associated with lower concentrations of inflammatory markers 5
Important Caveats
Stability of Inflammatory Markers
- Single measurements of inflammatory markers may only represent stable individual differences in the short term (<6 months) 2
- For intervals ≥6 months to 3 years, repeated measurements are recommended 2
- For intervals >3 years, repeated measurements are absolutely necessary to reliably identify stable individual differences in health risk 2
Non-Specificity
- Inflammatory markers are not specific to any single disease process 1, 6
- Low levels may not necessarily indicate absence of disease, as some conditions may not trigger systemic inflammation 6
- CRP has two isoforms, one produced during inflammation and another routinely produced in the absence of inflammation that may have anti-inflammatory effects 7
Contextual Interpretation
- Inflammatory markers should be interpreted alongside other clinical and laboratory findings 6
- IL-6 and CRP participate in somatic maintenance efforts and may indicate that an organism is investing in protection, preservation, or repair of tissue - not just inflammation 7
Clinical Application
- For cardiovascular risk assessment, two measurements of hsCRP (optimally 2 weeks apart) should be averaged for stable patients 1
- If a level >10 mg/L is identified, search for an obvious source of infection or inflammation, discard that result, and measure again in 2 weeks 2
- Inflammatory markers should be used as part of comprehensive risk assessment alongside traditional risk factors 1
- Serial testing of hsCRP should not be used to monitor effects of treatment (Class III, Level of Evidence C) 2
Factors Affecting Inflammatory Marker Levels
Factors that increase CRP levels:
- Elevated blood pressure
- Obesity
- Smoking
- Diabetes
- Low HDL/high triglycerides
- Hormone therapy
- Chronic infections/inflammation 1
Factors that decrease CRP levels:
- Moderate alcohol consumption
- Physical activity
- Weight loss
- Statins
- Fibrates
- Niacin 1
While low inflammatory markers generally suggest better health status, they should be viewed as one component of health assessment rather than a definitive indicator of overall health.