Cardiac C-Reactive Protein High Sensitive

High sensitive C-reactive protein (hsCRP) is a strong predictor of cardiovascular disease

Cardiovascular disease (CVD) is a major health burden: a high proportion of patients are not classified correctly or even missed entirely for cardiovascular (CV) risk assessment

  • More than 60% of those who develop coronary events have only one, or even none of the traditional risk factors, and more than half have either normal or mildly increased lipid values1
  • European Society of Cardiology’s (ESC) guidelines on CV risk prevention use the SCORE risk charts to estimate a 10-year risk of fatal CV disease, which takes into consideration age, smoking status, systolic blood pressure and total cholesterol2
  • Additional factors can be added to help further improve overall risk assessment2

hsCRP at a glance

The addition of Lipoprotein(a), hsCRP and Homocysteine can add new information to current risk models. This leads to a more accurate categorization of individuals at increased risk for CV disease.

(Montgomery, J.E., Brown, J.R. (2013). Vasc Health Risk Manag. 9, 37-45.)


hsCRP has been shown to be a predictor of CVD in multiple studies

  • Large scale prospective studies in the US and Europe have consistently shown the predictive value of CRP in CVD3,4
  • High sensitive C-reactive protein has been shown to be a better predictor of the risk of cardiovascular events than low-density lipoprotein (LDL) cholesterol3,6
  • In a meta-analysis of 22 studies with an average follow-up of 12 years, the top CRP tertile showed a 58 % increased cardiac risk compared to the bottom CRP tertile7
References

1 Young, I., Rifai, N. (2009). High-sensitivity C-reactive protein and cardiovascular disease. Clin Chem. 55, 201-2.
2 Perk, J. et al. (2012). European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 33(13), 1635-701.
3 Ridker, P.M. et al. (2002). Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 347, 1557–1565.
4 Koenig, W. et al. (2004). C-reactive protein modulates risk prediction based on the Framingham Score: implications for future risk assessment: results from a large cohort study in southern Germany. Circulation. Mar 23;109(11), 1349-53.
5 Erqou, S. et al. The Emerging Risk Factors Collaboration. Lipoprotein(a) Concentration and the Risk of Coronary Heart Disease, Stroke, and Nonvascular Mortality.JAMA. 2009;302(4):412-423. doi:10.1001/jama.2009.1063.
6 Yeh, E.T., Willerson, J.T. (2003). Coming of age of C-reactive protein: using inflammation markers in cardiology. Circulation. Jan 28;107(3), 370-1.
7 Wald, D.S. et al. (2002). Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis. BMJ 325, 1202.

Assay time 10 min
Sample material Serum, plasma
Sample volume 6 µL
Measuring range 0.15 - 20 mg/L
Intermediate precision (cobas c 501 module) 13.3 mg/L: CV: 2.1 %
0.53 mg/L: CV: 8.4 %
Repeatability (cobas c 501 module) 15.9 mg/L: CV: 0.4 %
0.54 mg/L: CV: 1.6 %

Risk prediction models can be improved by the addition of hsCRP

  • The addition of hsCRP to the Framingham risk score led to a net classification of 11.8% and 5.6% for Coronary Heart Disease (CHD) and Cardiovascular Disease (CVD) respectively1,2
  • More than 20% of all participants with intermediate risk could be reclassified with the addition of hsCRP3
hsCRP reclassification improvement

The net reclassification improvement when CRP was added to traditional factors was 5.6% for total CVD (P=0.014) and 11.8% for hard CHD (P=0.009).1,2

hsCRP is a major contributor to CVD risk

C-reactive protein has been shown to be a better predictor of the risk of cardiovascular events than low-density lipoprotein (LDL) cholesterol.

(Ridker, P.M. et al. (2002). Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 347, 1557–1565.)​

References


1 Wilson, P.W. et al. (2005). C-reactive protein and risk of cardiovascular disease in men and women from the Framingham Heart Study. Arch Intern Med;165, 24738.
2 Yousuf, O. et al. (2013). High-sensitivity C-reactive protein and cardiovascular disease: a resolute belief or an elusive link? J Am Coll Cardiol. Jul 30;62(5), 397-408.
3 Cook, N.R. et al. (2006). The effect of including C-reactive protein in cardiovascular risk prediction models for women. Ann Intern Med. Jul 4;145(1), 21-9.

The use of hsCRP in risk prediction is recommended by various guidelines

ESC guidelines recommend that hsCRP may be measured as part of refined risk assessment in patients with an unusual or moderate CV risk profile
Myers, G. et al. (2009). (NACB LMPG Committee Members). National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Emerging Biomarkers for Primary Prevention of Cardiovascular Disease. Clinical Chemistry. 55, 378–384.

If risk is intermediate (10 % – 20 %) and uncertainty remains as to the use of preventive therapies such as statins or Aspirin®, then hsCRP measurement might be useful for further stratification into a higher or lower risk category
Pearson, T.A. et al. (2003). Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation;107, 499-511.

The optional use of hsCRP to identify patients without known CVD who may be at higher absolute risk than estimated by major risk factors, specifically, those patients at intermediate risk (e.g., 10 % to 20 % risk of coronary heart disease over 10 years). Result can guide physicians in evaluation further diagnosis or treatment decision
Koenig, W. (2013). High-sensitivity C-reactive protein and atherosclerotic disease: from improved risk prediction to risk-guided therapy.
Int J Cardiol. Oct 15;168(6), 5126-34.