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New Test for Heart Disease
Daily Policy Digest

Health Issues / Preventive Medicine

Tuesday, November 19, 2002
A rarely performed test has been found to predict future heart disease even in the absences of high levels of "bad" cholesterol, called LDL. C-reactive protein (CRP) is a marker of inflammation that has been shown to be associated with an increased risk of heart attacks.

In addition to varying naturally between individuals, bloodstream CRP levels are elevated in smokers, diabetics and people who are overweight. It can be reduced in a variety of ways, including with exercise and weight loss, and by taking certain drugs, including the cholesterol-lowering medicines known as statins. Some experts believe the test may provide a rough "global summary" of a person's cardiovascular risk.

The two tests, however, clearly measured different things and identified different individuals.

  • Women with high CRP didn't necessarily have high LDL cholesterol, or vice-versa.
  • Many people whose increased risk was only evident when CRP was measured.
  • Women with above-average CRP and below-average LDL levels had more heart attacks and strokes than women with below-average CRP and above-average LDL.
  • However, the first group would be less likely to be prescribed preventive treatment than the second.
Analysts conclude that testing for the CRP level is a stronger predictor of cardiovascular events than the LDL cholesterol level and that it adds important information in predicting whom will develop heart disease.

In practical terms, the new findings are likely to launch a debate about whether -- or how soon -- routine CRP measurement should become a part of the complex calculation of heart attack risk that now goes on in thousands of doctors' offices every day. Others, however, think enough questions remain unanswered -- particularly the issue of whether CRP-lowering interventions are helpful -- to keep it out of workaday medicine for the time being.

Source: David Brown, "New Test for Risk of Heart Disease," New York Times, November 14, 2002; Paul M. Ridker, "Comparison of C-Reactive Protein and Low-Density Lipoprotein Cholesterol Levels in the Prediction of First Cardiovascular Events," New England Journal of Medicine, November 14.

For text
http://content.nejm.org/cgi/content/full/347/20/1557

For more on Preventive Medicine
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