Cardiologists call for routine measurement of C-reactive protein

The American College of Cardiology issued a new scientific statement highlighting that inflammation, measured with high-sensitivity C-reactive protein (hsCRP), strongly predicts risk of cardiovascular disease (CVD) events.

The statement, published by JACC on Sept. 29, is meant to provide an updated understanding of the role of chronic, low-grade inflammation in CVD, the authors said. They recommended that hsCRP be measured in all patients being evaluated for CVD risk for both primary and secondary prevention. The scientific statement details the data confirming the test's value in clinical decision making, noting that “Because clinicians will not treat what they do not measure, universal screening of hsCRP in both primary and secondary prevention patients, in combination with cholesterol, represents a major clinical opportunity and is therefore recommended.”

Although several other inflammatory biomarkers, such as serum amyloid A, IL-6, fibrinogen, white blood cell count, neutrophil-to-lymphocyte ratio, and eicosapentaenoic acid/arachidonic acid ratio, also predict risk, their routine evaluation adds little to hsCRP, the statement said.

A single measurement of hsCRP (>3 mg/L) when a patient is not acutely ill can be used to identify increased inflammatory risk, for which early initiation of lifestyle interventions is recommended, the statement said. If a patient has a persistently elevated hsCRP level, initiation or intensification of statin therapy should be considered for primary prevention, irrespective of the patient's low-density lipoprotein (LDL) cholesterol level.

In patients with known CVD, hsCRP level is at least as predictive of future events as LDL cholesterol levels, even during treatment with statin therapy, the statement said. If secondary prevention patients have an hsCRP above 2 mg/L, consideration should be given to increasing statin dosage. The statement also noted that low-dose colchicine is the first FDA-approved anti-inflammatory agent for reducing cardiovascular events in patients with chronic stable atherosclerosis.

The important role of lifestyle interventions to reduce systemic inflammation is also emphasized, including regular exercise and anti-inflammatory diet choices. “In aggregate, the evidence linking inflammation with atherosclerotic CVD is no longer exploratory but is compelling and clinically actionable,” the statement said. “The time for taking action has now arrived.”