Inflammation in atherothrombosis: how to use high-sensitivity C-reactive protein (hsCRP) in clinical practice

Abstract

Inflammation is now recognized as a critical contributor to the atherothrombotic process, and measurement of the inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) is a proven method to better predict cardiovascular risk and target therapeutic interventions. Following recommendations from the Centers for Disease Control and the American Heart Association, many physicians now routinely evaluate hsCRP along with cholesterol levels as a part of global risk prediction. Levels of hsCRP <1, 1-3, and >3 mg/L correspond to lower, moderate, and higher risk of cardiovascular events at all levels of the Framingham Risk Score and at all levels of metabolic syndrome. Interventions that lower hsCRP include diet, exercise, smoking cessation, statin therapy, and improved glycemic control. In addition to primary prevention, hsCRP is an important prognostic marker in acute coronary syndromes, following angioplasty, and in the long-term management of post-infarction patients. This article provides a clinically oriented overview of appropriate settings in which to measure hsCRP, how to interpret results, and how interventions to reduce vascular risk can be targeted on the basis of hsCRP findings.