In this presentation Dr. Ridker addresses the question of whether high-sensitivity C-reactive protein (hs-CRP) can be used to better predict the risk of heart attack and stroke.

High blood pressure, smoking, diabetes and high cholesterol are classical risk factors for coronary heart disease, but research shows that these risk factors cannot predict all cases of heart attack and stroke. Doctors are therefore interested to know about new risk factors that can help them identify more patients at high risk.

In the development of heart disease there is atherosclerosis, which involves the buildup of cholesterol plaques in the coronary arteries that normally carry oxygen to the heart muscle. The rupturing of these plaques is triggered by the immune system and leads to a heart attack.

Doctors can now use a simple blood test to monitor the immune system in terms of the risk of getting a heart attack or stroke. This test is called the high-sensitivity C-reactive protein test or hs-CRP.

Should hs-CRP therefore be tested along with cholesterol? This question was addressed in the Women's Health Study which had almost 28,000 initially healthy participants. The results showed that individuals with a low LDL or "bad" cholesterol level and high hs-CRP level were still at a higher risk of getting a heart attack or stroke than those at low risk having low hs-CRP and low LDL cholesterol levels. hs-CRP is also a useful predictor of risk in patients with the metabolic syndrome.

According to the current clinical guidelines, the hs-CRP test should be done at the discretion of the physician as part of the global risk assessment in individuals without known cardiovascular disease.

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After viewing this presentation you will be able to understand:

- why hs-CRP levels are considered as a predictor of future heart attack or stroke
- why hs-CRP testing may be carried out in addition to cholesterol testing
- what are the current clinical guidelines with regard to hs-CRP testing

Paul M. Ridker, M.D., Nader Rifai, Ph.D., Lynda Rose, M.S., Julie E. Buring, Sc.D., and Nancy R. Cook, Sc.D. Comparison of C-Reactive Protein and Low-Density Lipoprotein Cholesterol Levels in the Prediction of First Cardiovascular EventsNEJM 2002;347:1557-1565.

Paul M Ridker, MD.Clinical Application of C-Reactive Protein for Cardiovascular Disease Detection and Prevention Circulation. 2003;107:363.

Paul M Ridker, MD; Julie E. Buring, ScD; Nancy R. Cook, ScD; Nader Rifai, PhD.C-Reactive Protein, the Metabolic Syndrome, and Risk of Incident Cardiovascular Events Circulation. 2003;107:391.

Umesh N. Khot, MD; Monica B. Khot, MD; Christopher T. Bajzer, MD; Shelly K. Sapp, MS; E. Magnus Ohman, MD; Sorin J. Brener, MD; Stephen G. Ellis, MD; A. Michael Lincoff, MD; Eric J. Topol, MD.Prevalence of Conventional Risk Factors in Patients With Coronary Heart Disease JAMA. 2003;290:898-904.