From the Guidelines
A mildly elevated C-reactive protein (CRP) level indicates low-grade inflammation in your body, and according to the most recent guidelines 1, it warrants further investigation to identify the underlying cause, with risk assessment categorized into low risk, average risk, and high risk based on CRP population distributions.
Key Points to Consider
- Common reasons for mild CRP elevation include minor infections, obesity, smoking, lack of exercise, or chronic conditions like heart disease or arthritis, as noted in various studies 1.
- To address this, focus on lifestyle modifications including regular exercise (30 minutes daily), maintaining a healthy weight, following an anti-inflammatory diet rich in fruits, vegetables, and omega-3 fatty acids, quitting smoking, managing stress, and getting adequate sleep, which can help reduce inflammation naturally.
- If your CRP remains elevated or increases despite these measures, consult your healthcare provider for additional testing to rule out more serious conditions, as suggested by the clinical practice discussion group 1.
- CRP is an acute phase protein produced by the liver in response to inflammation, and monitoring its levels can help track your progress in reducing inflammation over time, with the understanding that high-sensitivity C-reactive protein (hsCRP) may be used at the discretion of the physician in patients judged by global risk assessment to be at intermediate risk for cardiovascular disease (CVD) 1.
Recommendations for Clinical Practice
- The American Heart Association recommends that CRP results should be expressed only as milligrams per liter and expressed to 1 decimal point 1.
- Patients with persistently unexplained marked elevation of hsCRP (10 mg/L) after repeated testing should be evaluated for noncardiovascular causes, as advised by the clinical practice discussion group 1.
- Lifestyle modifications and monitoring of CRP levels are crucial in managing and reducing inflammation, with the goal of improving overall health and reducing the risk of cardiovascular disease, as supported by various studies 1.
From the Research
Definition and Implications of Mildly Elevated CRP
- C-reactive protein (CRP) is a marker of systemic inflammation, and its levels are associated with cardiovascular risk 2, 3, 4, 5, 6.
- A mildly elevated CRP level is often considered to be between 3-10 mg/L, although the exact definition may vary depending on the context and population being studied 2.
Association with Cardiovascular Risk
- Studies have shown that elevated CRP levels are associated with an increased risk of cardiovascular events, including in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) 2, 4, 6.
- The relationship between CRP levels and cardiovascular risk is complex, and other factors such as disease activity, treatment, and traditional cardiovascular risk factors also play a role 3, 4, 6.
Effects of Treatment on CRP Levels
- Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to have varying effects on CRP levels, with some NSAIDs (such as naproxen) decreasing CRP levels and others (such as lumiracoxib) increasing CRP levels 5.
- The use of disease-modifying anti-rheumatic drugs (DMARDs) and biologics may also impact CRP levels, although the exact effects are not fully understood 3, 6.
Clinical Implications
- Elevated CRP levels, even in the mildly elevated range, may be associated with an increased risk of cardiovascular events in patients with RA and other inflammatory diseases 2, 4, 6.
- Actively targeting residual inflammatory risk, including CRP levels, may be important for reducing cardiovascular event rates in these patients 6.