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Add CRP to cholesterol screens.

A simple and inexpensive blood test for C-reactive protein (CRP)--an indicator of inflammation--may help physicians more accurately predict a person's risk of developing cardiovascular disease.

"The bottom line is that half of all heart attacks and strokes in the United States occur in people with normal cholesterol levels," says Harvard researcher Dr. Paul Ridker, who first identified C-reactive protein as a risk factor for heart disease. "When we combine the high-sensitivity CRP test with standard cholesterol screening, we can do a far better job of predicting who will ultimately go on to have a heart attack or stroke than if we had relied on cholesterol levels alone."

An estimated 25 to 30 million Americans have normal cholesterol levels and high CRP levels and may be at risk for a cardiac event. To learn more about this important new screening tool, MU interviewed Paul Ridker, M.D., director, Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital in Boston, Massachusetts.

Q: Should physicians routinely incorporate CRP testing along with cholesterol screening to monitor the overall risk profile of their patients?

A: The Centers for Disease Control and Prevention and the American Heart Association will be releasing screening guidelines in a few months. My best guess is that they are going to suggest CRP screening for primary prevention of cardiovascular disease in healthy middle-aged men and women. Early identification of patients with high CRP levels allows us to motivate them to diet, exercise, and stop smoking. It motivates them to stay within the treatment program. Compared to not knowing their high risk, it is extremely valuable information.

Q: Do age and gender play a role in the development of high levels of CRP?

A: Women who take hormone replacement therapy have elevated levels of CRP, but otherwise the levels in men and women are basically the same. There is a slight drift upwards in CRP levels as people age, similar to that observed with cholesterol readings.

Q: Is obesity a factor in CRP levels?

A: Obesity plays a very significant role. Fat cells produce chemicals called cytokines that lead to the production of CRP. We showed about a year and one half ago that CRP levels not only predict heart attack and stroke, but also diabetes. The concept is that the inflammatory response observed in obese patients also increases their risk of diabetes and heart disease. We believe the reason that obese patients have this cluster of diabetes and heart disease is largely related to the inflammation.

Q: Is CRP implicated in conditions other than heart disease and diabetes ?

A: As far as we can tell, CRP levels in healthy individuals predict future strokes, heart attacks, sudden cardiac death, and diabetes. Interestingly, it does not predict future cancer.

Q: Can lifestyle changes help reduce CRP levels?

A: The most important ways to lower CRP levels are to stop smoking, go to the gym and work out, and lose weight. These three things overwhelmingly lower your risk of heart disease and seem to lower your risk of diabetes as well.

Q: Could you tell us about your ongoing studies evaluating the role of aspirin and lipid-lowering drugs in decreasing CRP levels?

A: The aspirin story is fairly simple. We have shown that the benefit of aspirin is greatest among patients with high CRP levels. The statin data are much more complicated and interesting. We have been able to show that these LDL-lowering drugs--the statins--not only lower cholesterol, but they also lower CRP levels.

We recently launched a large nationwide trial called JUPITER and will begin enrolling 15,000 patients this spring. It is a unique study because we are recruiting patients who have very low cholesterol levels--the LDL level must be less than 130--and high CRP levels.

We will be looking at whether putting those patients on various drug therapies--including statins--can reduce the risk of a cardiac event. The holy grail is the development of therapies that are truly anti-inflammatory. Readers who might be interested in participating in the study should talk to their doctors.
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Title Annotation:Neighborhood Heart Watch; C-reactive protein
Author:Zipes, Douglas
Publication:Medical Update
Article Type:Interview
Geographic Code:1USA
Date:Dec 1, 2002
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