C-Reactive Protein and Cardiovascular Risk: Has the Time Come for Screening the General Population?

Abstract

C-Reactive protein (CRP), an exquisitely sensitive marker of systemic inflammation, has emerged as a powerful predictor of cardiovascular diseases, in particular of coronary heart disease (CHD) (1). The availability of high-sensitivity (hs) assays has enabled the detection of even low-grade inflammatory responses that have previously been regarded as clinically not meaningful. In this issue of the Journal, Rifai and Ridker (2) propose an algorithm using CRP concentrations together with the total cholesterol:HDL-cholesterol ratio, the most powerful predictor among lipoproteins, for cardiovascular risk assessment. They suggest risk stratification based on two consecutive hs-CRP measurements and categorizing subjects according to quintiles of hs-CRP and total cholesterol:HDL-cholesterol ratio. These quintiles were derived from ongoing population-based surveys, whereas risk estimates were taken from prospective studies in men and in women. CRP fulfills most of the requirements needed to serve as a new risk factor for CHD: (a) The consistency of results from 11 prospective population-based studies in initially healthy subjects has been remarkable. (b) The association between CRP and future coronary events is strong. The combined risk ratio for CHD from metaanalysis is 2 if subjects with baseline CRP concentrations in the upper tertile of the population distribution are compared with those in …