May 30, 2013Journal of the American College of Cardiology
High-Sensitivity C-Reactive Protein and Cardiovascular Disease
Key result
This review examines the biology, epidemiological association with cardiovascular disease, quality as a risk biomarker, and clinical utility of high-sensitivity C-reactive protein for statin therapy.
Why the study?
Despite existing guidelines, clear consensus is lacking regarding the optimal clinical use of hsCRP, its causative role in atherothrombosis, and its incremental value in cardiovascular risk prediction.
Key Points
- This review assesses the role of high-sensitivity C-reactive protein in cardiovascular disease risk prediction and statin therapy response.
- Review of the literature focusing on hsCRP's biology, epidemiological associations, and clinical applications.
- Analysis of recommendations from professional societies regarding hsCRP use in clinical practice.
- Evaluation of hsCRP's incremental predictive value beyond conventional risk factors.
- hsCRP is significantly associated with increased cardiovascular disease risk and inflammatory processes.
- Consensus on hsCRP's clinical utility for risk reclassification and statin therapy initiation remains unclear.
- Guidelines on hsCRP usage have been published, yet optimal clinical application shows variability.
PICO
P
Population
Cardiovascular disease
I
Intervention / Comparator
High-sensitivity C-reactive protein (hsCRP)
Limitations
- Definitive randomized evidence for its role as a causative factor in atherothrombosis is lacking
- Incremental predictive value beyond conventional factors remains debated
- Lack of clear consensus regarding optimal clinical use
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The ACC 2025 Scientific Statement is important both for clinicians and for evolving guidelines. Crucially, doctors will not treat what they do not measure and the scientific statement clearly and concisely calls for near universal hsCRP screening in both primary and secondary prevention. This is a reflection not of opinion, but of hard data: hsCRP has repeatedly proven to be as strong a predictor of heart attack, stroke and CV death as LDL cholesterol, yet is also fully independent; we can no longer assume we know what our patients' underlying biologic problem is by measuring LDL alone and ignoring silent vascular inflammation.”
“Those of us in the vascular biology community who have been thinking about this for the last 30 years recognize that it's now a real clinical issue that has to be dealt with by our clinical colleagues in daily practice—that's what this is all about. It's a very important document because it's a sea change in recognizing that the time has come to change how we practice medicine.”
“the time for taking action has now arrived”
Implication
This review highlights the ongoing debate and lack of consensus regarding the optimal clinical use of hsCRP for cardiovascular risk prediction and statin therapy guidance in primary prevention.
Abstract
The role of inflammation in the propagation of atherosclerosis and susceptibility to cardiovascular (CV) events is well established. Of the wide array of inflammatory biomarkers that have been studied, high-sensitivity C-reactive protein (hsCRP) has received the most attention for its use in screening and risk reclassification and as a predictor of clinical response to statin therapy. Although CRP is involved in the immunologic process that triggers vascular remodeling and plaque deposition and is associated with increased CV disease (CVD) risk, definitive randomized evidence for its role as a causative factor in atherothrombosis is lacking. Whether measurement of hsCRP levels provides consistent, clinically meaningful incremental predictive value in risk prediction and reclassification beyond conventional factors remains debated. Despite publication of guidelines on the use of hsCRP in CVD risk prediction by several leading professional organizations, there is a lack of clear consensus regarding the optimal clinical use of hsCRP. This article reviews 4 distinct points from the literature to better understand the current state and application of hsCRP in clinical practice: 1) the biology of hsCRP and its role in atherosclerosis; 2) the epidemiological association of hsCRP with CVD; 3) the quality of hsCRP as a biomarker of risk; and 4) the use of hsCRP as a tool to initiate or tailor statin therapy. Furthermore, we highlight recommendations from societies and important considerations when using hsCRP to guide treatment decisions in the primary prevention setting.
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Cite This Study
Yousuf et al. (2013) conducted a review in Cardiovascular disease. High-sensitivity C-reactive protein (hsCRP) was evaluated. This review examines the biology, epidemiological association with cardiovascular disease, quality as a risk biomarker, and clinical utility of high-sensitivity C-reactive protein for statin therapy.