Over the past decade it has become increasingly apparent that half of all heart attacks and strokes occur among individuals with normal cholesterol levels. In fact, recent studies suggest that 20 percent of all vascular events occur among those who do not have hyperlipidemia, hypertension, diabetes, or a smoking history. Thus, if the prevention of myocardial infarction and stroke is to improve, physicians and patients need to move beyond a reliance upon usual risk factors alone for the detection of heart disease risk. This issue is crucial for public health. Of the 1.5 million heart attacks that occur annually in the United States, one-third present as sudden death. Thus, the only preventive strategy that can work for many patients is improved early risk detection accompanied by aggressive lifestyle modification.

At the same time, one of the most promising areas of current vascular research has been uncovering the role of inflammation in heart disease. In this regard, biologic studies from many investigators worldwide have demonstrated that inflammation plays a crucial role in all stages of the development of heart disease, from early atherogenesis through acute plaque rupture and ultimately to re-infarction. Moreover, epidemiologic studies starting in the late 1990's began to demonstrate that many markers of inflammation are elevated among those at risk for future heart attack and stroke. Clinically, the most important of these biomarkers is high sensitivity C-reactive protein or hsCRP.

To date, there are close to 30 major prospective studies that demonstrate hsCRP levels to be associated with increased risk of future coronary disease at all levels of LDL cholesterol, at all levels of the metabolic syndrome, and at all levels of the Framingham Risk Score. Further, several studies now demonstrate that hsCRP levels predict the onset of type 2 diabetes, thus providing a link between early atherosclerosis and diabetes. These data are particularly important given the epidemic of obesity, diabetes, and heart disease that is ongoing worldwide. It is important to point out that it remains controversial as to whether C-Reactive Protein (CRP) reduction per se leads to reduced vascular event rates. However, several large clinical trials have now begun worldwide directly addressing this issue as well as the role of hsCRP as a method to better target preventive measures, both behavioral and pharmacologic.

Physicians are still in the process of learning about the inflammatory hypothesis of atherosclerosis. This is true not only in the cardiovascular community, but also in the much more important community of primary care and general internal medicine physicians where use of hsCRP is most applicable and where the greatest opportunities for prevention lie.

Academic researchers involved in different aspects of the inflammation story are acutely aware of the limitations of current educational material describing inflammation in general and C-Reactive Protein (CRP) in particular. Many of them are frequently called upon to provide critical appraisals of current evidence, particularly evidence that enabled the Centers for Disease Control and the American Heart Association to issue the first set of CRP based recommendations for clinical use of this novel approach to risk assessment. In an attempt to fill this gap, several experts have authored academic review articles covering this area and made contributions to new editions of major textbooks of internal medicine. However, in an age of electronic education, is apparent that other approaches to education are needed. This need for both physician and patient education goes to the core mission of CRPhealth.com.

In brief, CRPhealth.com provides in a single website a full range of information regarding inflammation and vascular risk that is appropriate for both physicians and lay audiences.

We conceived this project with the knowledge that there was no such site available on the web, and that CRPhealth.com would thus fill an important unmet clinical need. Indeed, a Google search for the term "C reactive protein" turns up over 580,000 items of which the great majority deal with cardiovascular issues. However, out of all these "hits" there was no single comprehensive source of information dedicated to C-Reactive Protein (CRP), making it impossible to get a cohesive picture of how CRP might be used in clinical practice.

It is important to recognize that the CRPhealth.com target audience is both the general public as well as physicians. Thus, a critical aim was to develop "patient friendly" information that is distinct from that intended for physician audiences. For example, the implication of an elevated hsCRP level for a patient should initially be an increased motivation for exercise, diet, smoking cessation, and lifestyle change. For the physician, however, the findings of an elevated hsCRP may also lead to a closer evaluation for metabolic syndrome and type 2 diabetes, as well as to a recognition that vascular risk is higher than anticipated, a change that might influence practice patterns for pharmacologic prophylaxis.

In sum, we believe several key educational needs are met by the availability of CRPhealth.com.

First, large numbers of patients at high vascular risk are not being detected even though a simple and inexpensive blood test has been available and endorsed for use by the American Heart Association and the Centers for Disease Control in appropriate patient groups.

Second, physician knowledge of the importance of inflammation in vascular disease remains poor, even in sub-specialty groups such as cardiovascular practitioners and endocrinologists. This problem is compounded among primary care physicians and generalists, the very group most likely to see the kinds of patients who might benefit from inflammation assessment.

Third, managing patients with elevated levels of hsCRP is a complex process that includes not only lifestyle changes, but also may include the need to evaluate for metabolic syndrome, premature atherosclerosis, and diabetes. Thus, disease management of those with elevated C-Reactive Protein (CRP) is a major challenge for health professionals.

Fourth, patient education about risk assessment and prevention is a crucial step toward the eradication of vascular disease. Physicians are aware that educated patients are motivated patients, and the more they can enlist their patients as allies in prevention, the greater the chances are of success.

Coronary heart disease and diabetes are major global health issues and there remain hundreds of thousands of lives at risk among otherwise healthy individuals who are unaware of their level of risk. We are hopeful that CRPhealth.com can play a role in improving this situation for both physicians and patients.

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