High sensitivity C-reactive protein (hs-CRP)

2009 Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult has recognized high sensitivity C-reactive protein (hs-CRP) as a major cardiovascular risk factor. According to the American Heart Association levels of hs-CRP lower than 1.0 mg/dl indicate low risk of developing cardiovascular disease while levels higher than 3.0 mg/dl indicates high risk. The risk is moderate with levels in between. In the JUPITER trial, those with hs-CRP more than 2 mg/dl, but otherwise low risk, when given 20 mg of rosuvastatin, had a 44% reduction in major vascular events, 54% reduction in myocardial infarction, 48% reduction in stroke, 46% reduction in the need for angioplasty or bypass surgery and 20% reduction in all-cause mortality. Similar risk reduction was seen in those with Framingham Risk Scores of 5% to 10% (6,091 persons) as well as in those with Framingham Risk Scores of 11% to 20% (7,340 persons). A recent meta-analysis of 9 studies involving more than a thousand patients have found that in stent restenosis is higher in those with elevated hs-CRP (Li JJ, et al. Impact of C-reactive protein on in-stent restenosis: a meta-analysis. Tex Heart Inst J 2010;37:49–57).