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)


  • 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.

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