CRP

CRP is an acute-phase reactant synthesized by the liver in response to cytokines released by damaged tissue. Production is controlled by interluekin-6, an inflammatory cytokine. Also, CRP is produced by cells in the vascular wall such as endothelial cells, smooth muscle cells, and also by adipose tissue

Hs CRP vs CRP
Traditional assays for CRP are insufficiently sensitive for measuring the lower serum values associated with atherosclerotic disease. The newer hs-CRP assays are capable of measuring serum CRP to below 0.6 mg/dL.

Chronic inflammation is pivotal in atherosclerosis

high-sensitivity CRP (hs-CRP), can be a marker of atherosclerosis. hs-CRP is an important predictor for cardiovascular events including MI , cerebrovascular events, peripheral vascular disease, and sudden cardiac death in individuals without a history of heart disease

High-sensitivity CRP testing has been shown to add to the predictive value of : total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL), as well as the Framingham 10-year risk score.

Indications/Applications
For follow-up and assessment of the risk of myocardial infarction in patients with acute coronary syndromes Assessing the risk of cardiovascular disease or ischemic events in asymptomatic individuals to determine strategy for prevention of cardiovascular events

Specific recommendations ACCF&AHA

hs-CRP testing may be useful in selecting patients for statin therapy in men 50 years and older or women 60 years and older with LDL less than 130 mg/dL who are not on lipid-lowering, hormone replacement, or immunosuppressant therapy, who are without clinical CHD, diabetes, chronic kidney disease, severe inflammatory conditions, or contraindications to statins.

Specific recommendations ACCF&AHA

hs-CRP testing may be reasonable for cardiovascular risk assessment in asymptomatic men 50 years and older or women 60 years and older at intermediate risk (eg, based on Framingham Risk Score) hs-CRP testing has not been shown to be beneficial for cardiovascular risk assessment and is not recommended in asymptomatic high-risk individuals.

 Oral contraceptives may increase serum CRP. Relative risk of future cardiovascular events based on hs-CRP testing is estimated as follows Low risk: CRP < 1.0 mg/L Intermediate risk: CRP 1.0-3.0 mg/L High risk: CRP > 3.0 mg/L

Biomark Med. 2012 Feb;6(1):19-34. High-sensitive C-reactive protein: universal prognostic and causative biomarker in heart disease? Rietzschel E, De Buyzere M. Department of Cardiology, University Hospital Ghent, Belgium.

the JUPITER trial that showed a benefit on outcome for treatment with rosuvastatin in primary prevention & treatment has been recommended in patients with a moderate Framingham Risk Score with a highsensitive CRPof >2 mg/l. However, adding CRP to risk charts and biomarker panels mostly yielded small and inconsistent improvements

References
High-sensitive C-reactive protein: universal prognostic and causative biomarker in heart disease? Ernst Rietzschel and Marc De Buyzere Biomarkers in Medicine, February 2012, Vol. 6, No. 1 , Pages 19-34 Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. Jan 28 2003;107(3):499-511. [Medline]. Casas JP, Shah T, Hingorani AD, Danesh J, Pepys MB. C-reactive protein and coronary heart disease: a critical review. J Intern Med. Oct 2008;264(4):295-314. [Medline]. Greenland P, Alpert JS, Beller GA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. Dec 21 2010;122(25):2748-64. [Medline]. Burris CA, Ashwood ER, Burns DE. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 4th ed. St Louis: Elsevier Saunders; 962-7, 1633. Devaraj S, Singh U, Jialal I. Human C-reactive protein and the metabolic syndrome. Curr Opin Lipidol. Jun 2009;20(3):182-9. [Medline]. [Full Text].