Role of high-sensitivity CRP in cardiovascular disease

Should an elevated high-sensitivity C-reactive protein (hs-CRP) be treated with statin medication in a patient with normal lipids and no other risk factors for coronary artery disease? My patient's hs-CRP was >3 mg/L and <5 mg/L on two separate occasions. He reports no chronic inflammatory diseases.—JIM STEELE, FNP, Chico, Calif.

Ongoing clinical trials are measuring the role of hs-CRP in cardiovascular disease. hs-CRP is more useful than CRP for predicting an otherwise healthy person's risk for cardiovascular disease and provides a window into the patient's overall inflammation status (something not captured by LDL and other lipid-related risk factors).

According to the American Heart Association, an hs-CRP >3.0 mg/L defines high risk while an hs-CRP of 1.0-3.0 mg/L indicates average risk.

Start with lifestyle modifications (e.g., weight reduction/control, diet and exercise program). Lower any other risk factors (e.g., hypertension), even if borderline. Aim for good glucose control. Smoking cessation and reduction of alcohol intake are advised. Initiating a low-dose statin could be justified if the benefits outweigh the risks, but the hs-CRP would have to be monitored for changes in the following months.—Debra Kleinschmidt, PhD, PA (137-2)

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