High Sensitivity C-Reactive Protein
Chester J. Zelasko, Ph.D. | December 13, 2005

Heart disease is the number-one cause of death in the United States and Canada. Trying to identify the best way to determine an individual’s risk of heart disease has been the focus of research for the past 40 years. This Newsletter will talk about the latest medical test that can more precisely indicate your risk of developing cardiovascular disease.

Defining Risk Factors for Heart Disease
Since the first report from the Framingham Study identifying total cholesterol (T-Chol) as a marker for cardiovascular disease, the medical field has tried to find a simple test that predicts your risk of developing heart disease (1). For many years, T-Chol was thought to be such an indicator. Based on the Framingham and other studies, the goal was to get T-Chol below 200 mg/dl.

Over time, researchers discovered that T-Chol was not as predictive as they might have hoped. Researchers from the same Framingham Study demonstrated that almost one-third of people with heart disease have T-Chol less than 200 mg/dl (2). Something else must be going on in addition to cholesterol.

HDL cholesterol (HDL-Chol), otherwise known as the good cholesterol, is also a measure of your risk of developing heart disease. HDL-Chol below 40 mg/dl is a risk factor for heart disease. Over 50 mg/dl is good; over 60 is even better. But HDL-Chol is difficult to change. Exercise, moderate alcohol consumption, and niacin supplementation seem to be the only effective means of raising HDL-Chol. For more information on how to raise HDL-Chol, see the Newsletter Raising HDL Cholesterol for September 30, 2005.

This raised the question: Is HDL-Chol the result of the presence of heart disease or is it the result of a poor lifestyle that contributes to heart disease? Low HDL-Chol generally occurs in people who smoke cigarettes, are sedentary, obese, insulin resistant or diabetic, have elevated triglycerides, or have chronic inflammatory disorders. This last factor--chronic inflammatory response--seems to have provided a key to a better marker for cardiovascular disease.

Inflammation and Heart Disease
When you have an infection of some sort, your body responds by initiating an inflammatory response. You’ll notice this when you have a cold or the flu because you’ll get a fever and other physical manifestations. But sometimes you’ll have a low-grade inflammatory response; the problem is that you won’t know it’s occurring. There may be damage to an artery or to other cells in your body. The body tries to fix the problem by initiating an inflammatory response. In fact, it may try too hard to fix the problem, resulting in disease. For example, an artery that had moderate atherosclerosis may close completely in as few as 3-6 months. Don’t get concerned--keep reading to find out what you can do about it.

A measure of this inflammatory response has been identified. C-reactive protein (CRP) is one of the acute-phase proteins that increase during systemic inflammation as just described. A simple blood test has been developed to assess this inflammation called high-sensitivity c-reactive protein or hs-CRP for short.

As an example, in a study of men in the Physicians Health Study and repeated for women in the Women's Health Study, those subjects with the highest hs-CRP levels had a risk of having heart disease almost three times greater than those with hs-CRP levels below 1.0 mg/L (3,4).

If you’re going to be tested, what are healthy levels of hs-CRP? Based on current research:
  • hs-CRP level lower than 1.0 mg/L indicates a low risk of developing cardiovascular disease
  • hs-CRP between 1.0 and 3.0 mg/L indicates an average risk of developing heart disease
  • hs-CRP higher than 3.0 mg/L, indicates a high risk of developing heart disease
Bottom Line: Know Your hs-CRP
hs-CRP is another piece of the hert disease assessment puzzle. This measure of inflammation, when combined with T-Chol, HDL-Chol, and LDL-Chol, can give you a greater understanding of your risk of having cardiac disease. They are not something to be afraid of or to avoid. Rather they’re markers to understand how you’re doing. Ask your physician to schedule this test. If your result is above the desirable range, it’s time to take action. With the right combination of diet, exercise, supplements, and if necessary, medications, you can lower your risk of having a heart attack. Use hs-CRP like percent body fat and blood pressure--as an indicator of health. If it’s not where it should be, that should move you to action, not inaction. That’s the path to better health and a better life.

References:
  1. Kannel WB et al. Risk Factors in Coronary Heart Disease. An Evaluation of Several Serum Lipids as Predictors of Coronary Heart Disease; The Framingham Study. Ann Intern Med. 1964 Nov;61:888-99.

  2. Castelli WP. Atherosclerosis. Lipids, risk factors, and ischemic heart disease. Atherosclerosis. 1996;124(suppl):S1-S9.

  3. Ridker PM et al. Inflammation, Aspirin, and the Risk of Cardiovascular Disease in Apparently Healthy Men. N Engl J Med 1997;336:973-979.

  4. Ridker PM et al. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation. 1998 Aug 25;98(8):731-3.
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