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Clinical Chemistry

Cardiac-related tests

High sensitivity C-reactive protein (hsCRP)


Author: Larry Bernstein, M.D., Triplex Consulting (see Reviewers/Authors page)
Revised: 12 December 2010, last major update December 2010
Copyright: (c) 2003-2010, PathologyOutlines.com, Inc.

General
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● hsCRP is an enhanced sensitivity C-reactive protein (CRP) immunoassay with a lowered measurement cutoff

Methodology
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● Laser nephelometry

Indications
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● In the JUPITER trial of apparently healthy persons without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels, rosuvastatin significantly reduced the incidence of major cardiovascular events ( N Engl J Med 2008;359:2195)
● This effect is thought to be due to the effect of statins on inflammation, which is detected by hsCRP
● hsCRP assessment for cardiovascular disease in asymptomatic individuals seems to be most useful for those classified as intermediate risk on the basis of traditional risk factors (e.g. an NCEP-ATP III global risk score between 5% and 20%), and who do not already warrant chronic treatment with aspirin and a statin

Limitations
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● Most useful for patients with intermediate risk for cardiovascular disease (Circ Cardiovasc Qual Outcomes 2008;1:92, Ann Intern Med 2009;151:483)
● For low risk patients, if their risk increases 3x (e.g. from 1% to 3%), their absolute cardiovascular risk is still low, so the hsCRP test has no practical value
● High risk patients are candidates for chronic aspirin and lipid-lowering therapy regardless of their hsCRP test results
● However, a recent study concludes that risk based statin treatment without hs-CRP testing is more cost-effective than hs-CRP screening, assuming that statins have good long-term safety and provide benefits among low-risk people with normal hs-CRP (Circulation 2010;122:1478)

Reference ranges
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● Low risk: under 1 mg/L
● Intermediate risk: 1-3 mg/L
● High risk: > 3 mg/L

Additional references
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Wikipedia, Circulation 2006;113:2335, N Engl J Med 2001;344:1959

End of Clinical Chemistry > Cardiac-related tests > High sensitivity CRP (hsCRP)


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