Review Article

Clinical Use of C-reactive Protein for Cardiovascular Disease

Authors: Dana E. King, MD, Arch G. Mainous, III, PHD, Marcia L. Taylor, MD

Abstract

Recent evidence supports an association between elevation of inflammatory markers, such as C-reactive protein, and subsequent cardiovascular disease risk. The American Heart Association released guidelines in 2003 to help clinicians know when to use such markers. Because inflammatory markers are associated with diabetes, obesity, and hypertension, knowledge of the role of such markers is extremely important for prevention and chronic disease management. Newer studies published after the guidelines, and another recent review provide further documentation of the growing role of inflammation in cardiovascular risk. Based on the available literature, this article reviews the new guidelines, more recent evidence since the guidelines, and forms recommendations for primary care clinical practice.


Key Points


* C-reactive protein (CRP) is the most clinically useful cardiovascular inflammatory marker, and is highly correlated with future cardiovascular risk.


* Highly sensitive CRP levels correlate with subsequent cardiovascular risk as follows: low risk (<1.0 mg/L), average risk (1.0–3.0 mg/L), and high risk (>3.0 mg/L). Individuals at high risk are at approximately two-fold greater risk of cardiovascular disease than low-risk persons.


* Screening of the entire adult low-risk population is not recommended. CRP screening is recommended as an adjunct for risk assessment for people at intermediate risk (eg, 10–20% risk of cardiovascular disease over the next 10 years).

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