Should C-Reactive Protein Be a Target of Therapy?

Abstract

Multiple studies have demonstrated that elevated levels of high-sensitivity C-reactive protein (hs-CRP) are associated with increased cardiovascular (CV) risk. Newer CV risk stratification strategies incorporating hs-CRP (e.g., Reynolds Risk Score) have also been shown to improve risk stratification better than algorithms incorporating only traditional risk factors. There is also evidence from several landmark statin trials that on-treatment hs-CRP levels predict the likelihood of CV events. Although there is increasing evidence that CRP may be directly involved in the pathogenesis of atherosclerosis, the question of whether reduction in CRP levels and/or its associated downstream effects will provide novel therapeutic avenues to reduce CV risk requires further investigation. CV diseases are the number one cause of mortality worldwide (1). Recent efforts directed at primary prevention of atherosclerosis have significantly reduced the incidence of initial clinical presentation of atherosclerosis. It is well established that patients with known diabetes or other traditional CV risk factors have an increased risk of atherosclerosis. Nonetheless, 15–20% of major CV events occur in patients with no major traditional CV risk factors (2). As a result, recent preventive efforts have been directed at finding newer, nontraditional, biomarkers to improve risk stratification, particularly in otherwise apparently low-risk individuals. hs-CRP, previously considered to be an indicator of systemic inflammation, has recently received much attention in the scientific literature, not only as a potential marker of increased atherosclerotic risk, but also as a potential target of therapy for the prevention of atherosclerotic CV disease. In this review, we discuss whether hs-CRP should indeed be a target for therapy in the prevention of CV disease as well as other potential clinical implications related to hs-CRP. Multiple studies have demonstrated that elevated levels of hs-CRP are clearly associated with increased CV risk (3,4). However, considerable controversy exists on whether CRP itself is …