From the Guidelines
Elevated cardiac CRP is a significant indicator of increased risk for cardiovascular disease, heart attack, or other cardiac events, and its measurement can be used to assess absolute risk for coronary disease primary prevention, particularly in individuals with multiple risk factors 1. When CRP levels are high in cardiac testing, it suggests an increased risk of cardiovascular disease. Normal CRP levels are typically below 3 mg/L, with levels above 3 mg/L indicating moderate risk and above 10 mg/L suggesting significant inflammation.
Key Points to Consider
- Elevated cardiac CRP often requires lifestyle modifications including regular exercise, heart-healthy diet, smoking cessation, and weight management.
- Medications like statins may be prescribed to reduce both inflammation and cholesterol.
- The value of CRP testing lies in its ability to detect inflammation that traditional risk factors might miss, as approximately half of heart attacks occur in people with normal cholesterol levels.
- Regular monitoring of CRP levels can help track cardiovascular risk over time and assess the effectiveness of preventive measures.
Clinical Application
According to the most recent guidelines, hsCRP measurement may be useful as an independent marker for assessing likelihood of recurrent events, including death, myocardial infarction, or restenosis after percutaneous coronary intervention 1. However, secondary preventive interventions with proven efficacy should not be dependent on hsCRP levels.
Limitations and Future Research
While the evidence supports the use of CRP testing in assessing cardiovascular risk, further research is needed to determine the effect on cardiovascular outcomes when hsCRP measurements are used to define further the LDL threshold for initiating lipid-lowering therapy 1. Additionally, multiple randomized clinical trials should be conducted to provide evidence on the outcomes associated with the use of hsCRP to guide the short- and long-term management of patients 1.
Patient Characteristics and Conditions
Patient characteristics and conditions associated with increased or decreased levels of hsCRP should be considered, including elevated blood pressure, cigarette smoking, and metabolic syndrome/diabetes mellitus, which are associated with increased levels of hsCRP 1.
From the Research
Elevated Cardiac CRP
Elevated cardiac C-reactive protein (CRP) is associated with increased cardiovascular risk, as it is a marker of inflammation that is directly involved in atherogenesis 2, 3, 4.
Association with Cardiovascular Risk
- Elevated CRP levels are associated with increased risk of coronary heart disease in general populations 3.
- High acute phase circulating CRP concentrations in individuals with substantial tissue damage are associated with death and cardiac complications 3.
- Modest but persistent increases in baseline CRP values in generally healthy subjects are also associated with increased cardiovascular risk 3, 4.
Relationship with Other Factors
- Statins and angiotensin II modulators have been shown to have an anti-inflammatory effect, as assessed by measurement of CRP levels, in patients with ischemic heart disease 5.
- Aspirin does not have a significant effect on decreasing CRP levels in patients with controlled hypertension and low inflammatory burden 6, 5.