Heart-disease risk and C-reactive protein.

In an important study reported this month, in which almost 28,000 healthy U.S. women were followed for eight years, the level of C-reactive protein, a marker of inflammation, was a better predictor than LDL cholesterol of first heart attack or related disease (1). And there was almost no correlation between the two markers (both blood tests)--meaning that these tests are finding different at-risk populations, and using both together would be a better predictor than using either alone. Smaller studies have already reported that high C-reactive protein was associated with heart attacks, strokes, and artery disease; the new study confirmed those findings with better data.

C-reactive protein is easy to measure, but this test is not yet generally used in clinical practice. Also, it has not been proven that interventions to reduce the inflammation will lower the risk of disease, although this appears likely. The authors conducted an earlier study (2) and recommend a larger trial of statins for this purpose.

These studies did not involve HIV. However, standard guidelines for lowering heart risk are often used in HIV treatment. And inflammation might be a greater problem in persons with HIV disease than in the general population.

The HIV community should follow this developing research (as well as other experimental tests for measuring heart risk, such as homocysteine levels). Some HIV-specific research would be easy to do--for example, testing whether certain populations have a higher level of C-reactive protein would require only one blood sample and laboratory test from each member of a cohort. Perhaps AIDS medicine could be a leader in bringing the new information into clinical practice.

References

(1.) Ridker PM, Rifai N, Rose L, Buring JE, and Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. New England Journal of Medicine. November 14, 2002; volume 347, number 20, pages 1557-1565.

(2.) Ridker PM, Rifai N, Clearfield M, and others. Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events. The New England Journal of Medicine. June 28, 2001; volume 344, pages 1959-1965.