Proposed Cardiovascular Risk Assessment Algorithm Using High-Sensitivity C-Reactive Protein and Lipid Screening

Abstract

Several prospective epidemiologic studies from the United States and Europe have demonstrated that high-sensitivity C-reactive protein (hs-CRP) is a predictor of future coronary events among apparently healthy men and women. For example, findings from the Multiple Risk Factors Intervention Trial demonstrated a correlation between hs-CRP and coronary heart disease mortality among male smokers followed over a 17-year period \[relative risk (RR) = 2.8; 95% confidence interval (CI), 1.4–5.4\] (1). A similar positive association between hs-CRP and future coronary events was noted in the Cardiovascular Health Study and Rural Health Promotion Project, which included elderly men and women with subclinical cardiovascular disease (2). A direct positive association between hs-CRP and future coronary events was also reported in apparently healthy men from the Physician’s Health Study (PHS); those in the highest quartile of hs-CRP had twice the risk of future stroke (RR = 1.9; 95% CI, 1.1–3.3), three times the risk of future myocardial infarction (RR = 2.9; 95% CI, 1.8–4.6), and four times the risk of future peripheral vascular disease (RR = 4.1; 95% CI, 1.2–6.0) (3)(4). Furthermore, both the MONICA-Augsburg cohort (5) and the Helsinki Heart Study (6) showed that compared with those with low hs-CRP, individuals with the highest hs-CRP concentrations were at approximately three times the risk of developing future coronary events. Finally, two reports from the Women’s Health Study (WHS) showed that hs-CRP is also a strong predictor of future cardiovascular events in women (RR = 4.4; 95% CI, 2.2–8.9) (7)(8). In fact, in that study, which directly compared several novel risk factors to standard lipid screening, hs-CRP was the single strongest predictor of future vascular risk …