Journals Club - CRP levels and cardiovascular disease

Curriculum statement 15.1 Cardiovascular problems.

Key trials

  • One study showed that middle-aged men without cardiovascular disease (CVD) who had raised CRP levels were more likely to die from a cardiovascular cause compared with those with low CRP levels (Eur Heart J 2005; 26: 1,783-9).
  • Several studies indicate that the CRP level achieved after initiation of statins may be as important as the actual LDL cholesterol level achieved (Am J Cardiol 2006; 97: 33A).
  • One study showed that in patients with stable coronary artery disease, an elevated high-sensitivity CRP (hs-CRP) level, even >1mg/l, was a significant predictor of adverse cardiovascular events (Circulation 2007; 115: 1,528-36).
  • A recent randomised trial of rosuvastatin in patients with relatively low LDL concentrations (<3.36mmol/l) but high sensitivity CRP (hs-CRP) [s40]2mg/l showed significant reductions in CVD events and total mortality (N Engl J Med 2008; 359: 2,195-207).

Evidence base

  • A BMJ editorial has stated that no change in practice is warranted on the basis of the JUPITER study (BMJ 2008; 337: a2,576).
  • One US study has stated that CRP levels may be most effectively used in patients at intermediate risk of vascular events to offer a moderate improvement in reclassification of risk (Circ Cardiovasc Qual Outcomes 2008; 1: 92-7)

Guidelines

  • The British Heart Foundation states that at present there are insufficient grounds for measuring CRP as a guide to CHD risk.
  • The European Society of Cardiology states that measurement of plasma hs-CRP is reasonable for assessing absolute risk for coronary disease primary prevention, particularly in intermediate risk individuals.

The currently recommended plasma hs-CRP cut offs are <1.0mg/l for low risk, 1.0-3.0mg/l for average risk, and >3.0mg/l for high risk.

  • The American Heart Association guidelines suggest using hs-CRP for patients with 10-year Framingham CVD risks of 10-20 per cent. If patients have hs-CRP >3 mg/l this will double their calculated CVD risk.
  • Until the risk/benefit balance of screening for CRP is fully explored, a policy of CRP screening to all of our patients, especially those without CVD, should not be introduced.

Contributed by Dr Louise Newson, a GP in the West Midlands

Key points

  • CRP levels may be a future screening test for CHD.
  • Mortality is higher for CHD patients with raised CRP levels.
  • CRP may be used in the future as an additional assessment of cardio-vascular risk in those with intermediate CVD risk.
  • There is no formal CRP testing recommended in the UK, even in those with CVD.

Useful websites

VIEW OUR ONLINE HEALTHY CHOLESTEROL LIFESTYLES RESOURCE CENTRE

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Before commenting please read our rules for commenting on articles.

If you see a comment you find offensive, you can flag it as inappropriate. In the top right-hand corner of an individual comment, you will see 'flag as inappropriate'. Clicking this prompts us to review the comment. For further information see our rules for commenting on articles.

comments powered by Disqus