August 14, 2002
ALBANY, N.Y. (The Albany Times Union) -- You might know your cholesterol. But what about your CRP?
People worried about their chance of getting heart disease may soon become familiar with the concept of C-reactive protein. CRP indicates a person's blood vessels may be swollen, a condition national experts have now shown to be a key risk factor for heart attack.
Sound new? To most people, it is. But even while national recommendations are being finalized to guide doctors on CRP testing, some cardiologists already use the measure.
"It's going to become an important tool, similar to what the LDL cholesterol is," said Dr. Jan L. Houghton, academic director of interventional cardiology at the Albany Medical Center. LDL (low density lipoprotein) is considered the worse of two commonly measured cholesterol components.
Doctors have long recognized increases in CRP as an indicator of inflammation of any type. What the new research has shown is that even very low levels of the protein can reveal smoldering, widespread blood vessel swelling that could spark a heart attack. So for the past couple of years, cardiologists have checked for "high sensitivity CRP levels" - below the numbers they previously thought relevant - along with other measures of heart disease risk.
Anything harmful to the blood vessel walls will cause them to swell, Houghton said. Smoking will do it, as will high blood pressure, which puts extra stress on veins and arteries. Both are long-established risk factors for heart disease.
"Now there seems to be more understanding of how these risk factors cause heart disease," Houghton said.
Some doctors already are finding CRP useful when a patient has other borderline risk factors for heart disease. Cardiologists may hesitate to prescribe a cholesterol-reducing statin drug, such as Lipitor or Pravachol, to someone whose LDL levels are rising but still acceptable. That is when Dr. Jonathan DeSantis, chief of cardiology at St. Peter's Hospital in Albany, takes a careful look at CRP. If that's high, he's apt to suggest a statin, which, it turns out, reduces vascular inflammation, too.
"It definitely impacts decisions day to day," DeSantis said of CRP.
Some doctors don't think CRP will ever replace cholesterol or other measures of heart disease risk, or that people will swap their CRP levels at the water cooler any time soon. Nor should people look at blood test results and assume they should be taking cholesterol reducers to knock their CRP down, doctors said.
But the new understanding of vascular inflammation offers hope that new drugs could target it specifically - and do a better job of reducing some patients' risk of getting heart disease, DeSantis said.
Houghton already uses CRP to encourage patients to change bad habits that lead to unhealthy hearts.
"Before, it was sort of a nebulous subject: "You smoke, so you're at risk.
You have high blood pressure, so you're at risk,"' Houghton said.
Now, she can point to a rising CRP level and tell patients she suspects their behavior or other problems are causing inflammation of their blood vessels. That has led to success in changing long-established bad habits, Houghton said.
CRP is not a perfect measure, and doctors stress that it won't be useful in every patient.
Doctors across the country are awaiting recommendations from federal health officials, due out this fall, that will guide them in who to test for CRP and how to interpret the results.
Some, like Houghton, predict that the simple blood tests will become as common as those for cholesterol, which are recommended for adults once every five years.
"It's definitely going to be really big, and it's going to help a lot of people," Houghton said.
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