What is the relevance of a cardiac C reactive protein (CRP) level in a patient with an underlying inflammatory condition, such as rheumatoid arthritis?—DIANE RADER, PA-C, Davis, W.Va.

The liver produces CRP in response to inflammation, tissue damage, and infection. Long used as a marker of systemic inflammation, CRP has received increasing attention as the role of inflammation in myocardial disease has become better understood. While several studies have shown the independent predictive value of CRP as a marker in primary screening for and prevention of atherosclerosis and acute coronary syndrome (AACN Clin Issues. 2004;15:547-557), efforts to lower CRP have not been proven to reduce risk. Nevertheless, CRP retains a role in the prognostic assessment of primary and recurrent events. This prognosis must be made in the context of other causes of systemic inflammation in individual patients. Those who have chronic inflammatory conditions, such as rheumatoid arthritis, may have elevated CRP secondary to their underlying illness. Inflammatory markers cannot be reliably used as independent indications when screening for myocardial inflammation in these patients.—Claire Babcock O’Connell, MPH, PA-C (147-7)