How specific is the C reactive protein (CRP) level in identifying patients with underlying CAD? If a patient has a high CRP and a therapeutic level of LDL, would you recommend increasing his statin dosage to help lower the CRP?
—Nazem Abdelfattah, MD, Grand Blanc, Mich.

Although many inflammatory markers predict risk of cardiovascular events, high-sensitivity CRP (hs-CRP) has the best profile to date for clinical applicability. Nevertheless, its role in clinical practice is still being determined (Circulation. 2003;107:499-511). Measurement of the hs-CRP can be used as part of a global risk assessment in patients without manifest CVD and is still predictive of increased risk in a patient with a therapeutic level of LDL. This marker certainly can be used to educate and motivate patients further in important diet and lifestyle modification. Several studies have demonstrated reduction in hs-CRP with a variety of statins and with the combination of statin and ezetimibe (Circulation. 2003;107:2409-2415 and Am J Cardiol. 2003;92:1414-1418). However, we do not yet have data on whether this reduction of hs-CRP levels translates into improved clinical outcomes.
—Norma M. Keller, MD (116-23)

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