In this presentation Dr. Koenig discusses the mounting evidence in support of C-reactive protein (CRP) as an important risk factor for cardiovascular disease (CVD).

Traditional risk factors are a useful first step in determining who could be at risk for a coronary event, however, these risk factors are prevalent in the general population, in particular in Western populations, says Dr. Koenig, and from that perspective there is some overlap between those individuals who will go on to have a cardiovascular event and those who will not. Further, not all patients with coronary heart disease have these risk factors (1). For these reasons it is of interest to take into account other factors that can improve risk prediction, especially in those with an intermediate level of global risk.

A novel cardiovascular risk factor would have to fulfill certain criteria in order to be used in clinical practice - it has to add independent information on risk or prognosis, and account for a clinically significant proportion of disease. The test should be reliable and accurate, provide good sensitivity, specificity and predictive value, and it should be available and practical for widespread application. The high-sensitivity CRP (hs-CRP) test has good precision, is done at a low cost, has good standardization and an easy preanalytic situation.

The value of CRP as a critical marker of cardiovascular risk can be seen through the whole spectrum of hs-CRP levels (2), provided that other factors influencing the CRP level, such as a current infection or trauma, are not present. There has recently been some controversy raised by the Reykjavik Study concerning the usefulness of hs-CRP testing for coronary heart disease risk prediction. Dr. Koenig talks about the findings and problems in this study, and addresses other concerns about the validity of hs-CRP testing for CVD risk prediction.

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After viewing this presentation the participant will be able to discuss:

- Advantages of the high-sensitivity CRP test
- Evidence for CRP as a strong independent marker of future cardiovascular events
- Evidence for improvement of long-term risk prediction by CRP in those at intermediate risk

1. 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 Aug 20;290(7):898-904.

2. Paul M Ridker, MD, MPH; Nancy Cook, ScDClinical Usefulness of Very High and Very Low Levels of C-Reactive Protein Across the Full Range of Framingham Risk Scores Circulation. 2004;109:1955-1959.