Blood Test Could Help Prevent Heart Deaths
Thousands of Deaths Could Be Prevented Each Year by Measuring C-Reactive Protein, Scientists Say
The Payoff continued...
"There are now over 30 major studies that have shown that CRP levels independently predict heart attack risk," Ridker says. "What has been missing is direct evidence that if you lower CRP you could lower cardiac risk. Now we have two independent papers coming out simultaneously that show this."
The Cleveland Clinic researchers measured arterial plaque buildup along with LDL and CRP levels in 502 patients with heart disease being treated with statin drugs. They found that cholesterol and inflammation levels independently predicted the progression of atherosclerosis.
"The striking thing was that about half the benefit of these drugs came not from lowering cholesterol but from lowering CRP levels," Nissen says. "This means that if a patient has achieved target cholesterol levels on statin therapy but still has elevated CRP, then more aggressive treatment is called for. If you don't work to get CRP levels down you are only getting half the benefits of statin therapy."
The target LDL cholesterol level for very high risk patients on statin drugs was recently lowered from 100 mg/dL to 70 mg/dL.
There are no uniform guidelines for optimal CRP, but Ridker says the goal for heart disease patients should be to lower CRP levels to below 2 mg/L.
American Heart Association spokesperson Sidney Smith Jr., MD, says it is clear from the two studies that some patients could benefit from more aggressive statin treatment. But the optimal treatment strategy for patients who have elevated CRP levels despite aggressive statin treatment is not yet clear, he says.
"We need a better understanding of which therapeutic strategies work best in people whose CRP levels aren't lowered with statins," he says.
Smith says the studies do argue in favor of including CRP in the tests used to monitor patients with cardiovascular disease. Ridker says the next step is to get that message to doctors and their patients.
"The challenge is to educate physicians and patients about the importance of CRP measurement and CRP reduction, just as we did a decade ago when we taught them about LDL measurement and reduction," he says.