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Comparison of C-reactive Protein
and LDL Cholesterol Levels
(American Heart Association) 14/11/2002
In a group of more than 27,000 women participating
in the ongoing Women's Health Study, elevated levels of C-reactive
protein (CRP), a blood-marker for inflammation, was a better predictor
of risk for future cardiovascular (CVD) events than elevated low-density
lipoprotein (LDL) cholesterol levels. The researchers note that
a combined evaluation of CRP and LDL may be a superior method of
risk detection because they appear to complement each other. They
caution, however, that more data needs to be collected on CRP before
these results can be translated into clinical practice.
"We believe CRP measurement should be seriously
evaluated as part of a strategy in assessing an individual's global
cardiovascular disease risk," says Robert O. Bonow M.D., president
of the American Heart Association. Global risk estimation combines
information from all existing risk factors, such as elevated LDL,
high blood pressure and smoking status, to determine a person's
overall risk for developing cardiovascular disease in the next ten
years.
"The American Heart Association and the Centers
for Disease Control and Prevention will be issuing a joint report
within the next several months that will include recommendations
on CRP screening," says Bonow. In developing these recommendations,
the role of CRP in clinical practice will be the focus of a special
session on Sunday, November 17 during the American Heart Association's
75th annual Scientific Sessions in Chicago.
"As the study authors note, many individuals
who have a cardiovascular event, such as a heart attack, have LDL
cholesterol levels below 130 milligrams per deciliter, which means
they may not have met criteria for lowering LDL with medications
prior to their heart attack. However, a large-scale clinical trial
should be able to determine if individuals with low LDL but elevated
CRP may ultimately be good candidates for medical therapy with statin
drugs, because these cholesterol-lowering drugs also seem to lower
CRP levels," Bonow says.
"These results from the Women's Health Study
also give credence to the growing body of evidence suggesting that
atherosclerosis is an inflammatory process," he says.
Inflammation is the body's response to injury, and is believed to
be a key component of atherosclerosis, the disease process that
causes fatty deposits to build up in the lining of arteries.
The causes for the low-grade inflammation that may
increase the risk of cardiovascular disease are uncertain, but experts
hypothesize that a bacterial or viral infection might contribute
to or cause atherosclerosis. Additionally, it is still not certain
whether the CRP elevations are a result of atherosclerosis, rather
than a marker for a causative agent, such as a bacteria or virus.
Determining the association between CRP and CVD risk is important,
because it may lead to better treatments for preventing heart attack
and stroke.
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