When considering biomarkers such as LDL-C, hsCRP and HDL-C, it is of interest to know their usefulness for predicting the risk of future vascular events, and for monitoring drug effectiveness.

There is data to suggest that hsCRP may be a better predictor of the risk of future cardiovascular (CV) events, such as from participants in the Women's Health Study directly comparing LDL-C, HDL-C and hsCRP, where it was found that hsCRP was the single strongest predictor of risk (1). hsCRP was also shown to enter risk prediction models before HDL-C and LDL-C (2,3).

There is also the LDL-stroke paradox to consider, in that LDL-C is a poor predictor of the risk of stroke, but statins clearly reduce stroke risk; hsCRP levels have been shown as a good predictor of incident stroke. Some therapies such as HRT and torcetrapib while lowering LDL-C and increasing HDL-C don't lower hsCRP or CV event rates. LDL-C and hsCRP are however both strong, independent predictors of the risk of future cardiovascular events, and both are lowered with statin treatment. LDL-C and hsCRP levels achieved after starting statin therapy are predictive of recurrent events (4), and hence the notion of dual goals based on achieved LDL-C and hsCRP is entering clinical practice.

Dr. Ridker discusses these findings in more detail and compares several cardiovascular interventions in their ability to reduce LDL-C, increase HDL-C, reduce hsCRP and reduce CV event rates.

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- LDL-C, HDL-C and hsCRP as predictors of the risk of future cardiovascular events
- The “LDL - stroke paradox”
- Clinical relevance of achieved LDL-C and hsCRP after starting statin therapy (PROVE IT - TIMI 22 trial)
- Effects of different interventions on LDL-C, HDL-C, hsCRP and cardiovascular event rates

1. Paul M. Ridker, M.D., Charles H. Hennekens, M.D., Julie E. Buring, Sc.D., and Nader Rifai, Ph.D.C-Reactive Protein and Other Markers of Inflammation in the Prediction of Cardiovascular Disease in Women NEJM 2000;Volume 342:836-843.

2. Nancy R. Cook, ScD; Julie E. Buring, ScD; and Paul M Ridker, MD The Effect of Including C-Reactive Protein in Cardiovascular Risk Prediction Models for Women Ann Int Med 4 July 2006 | Volume 145 Issue 1 | Pages 21-29.

3. Boekholdt SM, Hack CE, Sandhu MS, Luben R, Bingham SA, Wareham NJ, Peters RJ,
Jukema JW, Day NE, Kastelein JJ, Khaw KT.
C-reactive protein levels and coronary artery disease incidence and mortality in apparently healthy men and women: The EPIC-Norfolk prospective population study 1993–2003 Atherosclerosis. 2006 Aug;187(2):415-22.

4. 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 Therapy NEJM 2005;Volume 352:20-28.