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The use of high-sensitivity assays for C-reactive protein in clinical practice

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 621–635 (2008)Cite this article

Abstract

High-sensitivity assays that accurately measure levels of the inflammatory biomarker C-reactive protein have been proposed for use in assessments of risk for cardiovascular disease (CVD). A growing body of evidence supports recommendations for these tests in selected asymptomatic individuals deemed to be at intermediate risk of CVD according to traditional risk-factor assessments and who do not already warrant chronic treatment with aspirin and statin therapy. Data suggests that these high-sensitivity assays should be used in combination with measurements of LDL-cholesterol levels to assist risk stratification of selected patients for prevention of CVD.

Key Points

  • In asymptomatic individuals, C-reactive protein (CRP) levels are associated with risk of cardiovascular disease, including both coronary events and stroke, independent of traditional risk factors

  • High-sensitivity CRP assay results add predictive power to current coronary risk scores for some intermediate-risk individuals and, in some individuals, could highlight a need for treatment with chronic aspirin and statin therapy if not already on therapy

  • CRP levels are associated with clinical outcomes in high-risk individuals treated with statin therapy and, in some individuals, measurement of CRP in conjunction with LDL cholesterol could be useful

  • CRP levels are associated with incident diabetes mellitus and cardiovascular disease outcomes in individuals with the metabolic syndrome

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Acknowledgements

Charles P Vega, University of California, Irvine, CA, and A Del Negro, Medscape Cardiology, New York, NY, are the authors of and are solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. K Musunuru, BG Kral, CY Campbell and TJ Gluckman are all Clinical Fellows, RS Blumenthal is Professor of Medicine, and RA Lange is the E Cowles Andrus Professor of Cardiology at the Johns Hopkins Ciccarone Preventive Cardiology Center, Johns Hopkins University School of Medicine, Baltimore, MD.,

    Kiran Musunuru, Brian G Kral, Roger S Blumenthal, Catherine Y Campbell, Ty J Gluckman & Richard A Lange

  2. V Fuster is Director of the Zena and Michael A Wiener Cardiovascular Institute and the Marie-José and Henry R Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY.,

    Valentin Fuster

  3. E Topol is Director of Scripps Genomic Medicine at Scripps Translational Science Institute, La Jolla, CA.,

    Eric J Topol

  4. JT Willerson is President-Elect and Medical Director at St Luke's Episcopal Hospital/Texas Heart Institute, Houston, TX.,

    James T Willerson

  5. MY Desai is Assistant Professor of Medicine at the Department of Cardiovascular Medicine, Cleveland Clinic Foundation, and Lerner College of Medicine, Case Western Reserve University, Cleveland, OH.,

    Milind Y Desai

  6. MH Davidson is Director of Preventive Cardiology and Atherosclerosis Research and Clinical Professor of Medicine at University of Chicago School of Medicine, Chicago, IL.,

    Michael H Davidson

  7. S Mora is Associate Physician and Assistant Professor of Medicine at the Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,

    Samia Mora

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  1. Kiran Musunuru
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Correspondence to Kiran Musunuru.

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Competing interests

K Musunuru has served as a consultant for Alnylam Pharmaceuticals within the last year. TJ Gluckman has received honoraria from Sanofi-Aventis and Pfizer and has served as a consultant for Merck within the last year. MH Davidson has received honoraria from and served as a consultant for diaDexus within the last year. They declare no conflicts of interest pertaining to this topic. The other authors declared no competing interests.

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Musunuru, K., Kral, B., Blumenthal, R. et al. The use of high-sensitivity assays for C-reactive protein in clinical practice. Nat Rev Cardiol 5, 621–635 (2008). https://doi.org/10.1038/ncpcardio1322

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