Preventive cardiology: move over low density lipoprotein cholesterol, hello C-reactive protein?

Abstract

The inflammatory marker C-reactive protein (CRP) is a highly promising cardiovascular risk factor. The data associating high sensitivity CRP (hsCRP) to atherosclerotic vascular disease, especially coronary artery disease, are strong, consistent and have been tested across many populations. Multivariate analysis shows that hsCRP has an independent predictive value to the prediction of coronary artery disease along with the conventional cardiovascular risk factors such as sex, age, cigarette smoking, blood pressure, diabetes, elevated total cholesterol (or low density lipoprotein cholesterol) and high density lipoprotein cholesterol. Retrospective analysis of published clinical trials show that individuals with elevated hsCRP benefit from the use of acetylsalicylic acid and/or the statin class of medication. Before implementing a public health policy that includes the measurement and clinical decision-making algorithm using hsCRP, several conditions must be met. Among them, a better understanding of the biology of CRP, an indepth scrutiny at the link between hsCRP levels, the metabolic syndrome, and abdominal obesity and finally, clinical trials, currently underway that will test the hypothesis that patients with elevated levels of hsCRP but a normal low density lipoprotein-cholesterol benefit from a pharmacological intervention for cardiovascular prevention in a primary prevention setting.