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.
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.
“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.”
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.