The prevalence of conventional risk factors in patients with coronary heart disease is not uniform. Dr. Ridker discusses the Framingham risk score, which is used to predict the risk of cardiovascular events in patients and to determine whether therapy should be initiated. He raises the issue of patients who do not present risk factors, but who, for reasons such a genetic predisposition, are also at risk and are not treated consequently.

Dr. Ridker mentions a number of biomarkers for heart disease and suggests high-sensitivity C-reactive protein (hs-CRP) as a predictor of cardiovascular events, in combination with lipid measurements. He cites studies that demonstrate this correlation and other studies that demonstrate the usefulness of hs-CRP in targeting patients who should receive statin therapy. Hs-CRP appears to be at least as useful as LDL levels in predicting the risk of cardiovascular events. This is the basis for the JUPITER trial, a randomized trial of statin therapy among patients who have elevated hs-CRP, but who do not qualify for statin therapy due to low levels of LDL.

Dr. Ridker suggests, in view of the data he presents, that the Framingham risk score be modified to include the measurement of hs-CRP. He also briefly mentions the research currently being conducted about the possibility of CRP-targeting medication for the treatment of heart disease.

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

-Traditional algorithms and risk factors for measuring the risk of cardiovascular events
-The correlation between CRP levels and the risk of cardiovascular events
-The potential of high-sensitivity CRP (hs-CRP) to target patients who would benefit from statin therapy

Paul M Ridker, M.D., Christopher P. Cannon, M.D., David Morrow, M.D., Nader Rifai, Ph.D., Lynda M. Rose, M.S., Carolyn H. McCabe, B.S., Marc A. Pfeffer, M.D., Ph.D., Eugene Braunwald, M.D., for the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 (PROVE IT–TIMI 22) InvestigatorsC-Reactive Protein Levels and Outcomes after Statin TherapyNEJM 2005;Volume 352:20-28.