Coronary Heart Disease Risk Factors - Part II
C-Reactive Protein (CRP)
C-Reactive Protein (CRP) is a protein produced by the liver. It is considered a useful biological marker for arterial inflammation, and is found to have some ability to predict the risk of heart attacks and stroke.
Reference 6 presents much information that indicates the CRP is an independent risk factor - people with low LDL (e.g., "conventional" low risk) but with high CRP have a high risk for CHD, often missed in clinical practice. It suggests that having low LDL with high CRP carries roughly the same risk as having high LDL with low CRP.
A later critical review published in reference 7 states that the large effect seen in the previous studies is diminished when other effects such as body-mass-index, abdominal fat, and physical activity are considered. In another reevaluation that is a meta-study including later studies (reference 8), they derive a relative risk ratio of only 1.49 between the highest and the lowest values of CRP. They state that the relative independent risk for patients who have high cholesterol levels or who smoked, is considerably higher.
Despite initial high hopes that a new and good-quality discriminating factor between high- and low-risk people has been found, ultimate extensive analysis shows otherwise. To quote a sentence from reference 9, "C-reactive protein is a relatively moderate predictor of coronary heart disease. Recommendations regarding its use in predicting the likelihood of coronary heart disease may need to be reviewed."
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