The high cost of diagnostic methods, even of biochemical markers, limit many of the tools necessary for the diagnosis of CAD, especially if we consider the group of low-risk patients. Can CRP be a cost-effective strategy, as some studies have shown, to stratify these low-risk patient groups and separate which should effectively continue the investigation to elucidate the presence of CAD?
The value of CRP levels depends on whether one falls into one of three CV-risk groups (Low, Intermediate and High). In low risk group, the higher level of CRP will not put a patient on danger zone but will requires lifestyle changes. Probably it is not necessary to have massive screening set up for LOW risk group. It will be helpful to know CRP level in intermediate risk group, because it can provide vital information for treatment. High risk patients are probably under medications.
This tells it all: Hemingway H, Philipson P, Chen R, Fitzpatrick NK, Damant J, Shipley M, Abrams KR, Moreno S, McAllister KS, Palmer S, Kaski JC, Timmis AD, Hingorani AD.Evaluating the quality of research into a single prognostic biomarker: a
systematic review and meta-analysis of 83 studies of C-reactive protein in stable
coronary artery disease. PLoS Med. 2010; 7: e1000286.
C-reactive protein (CRP) ultrasensitive of hepatic origin, is a new bio
marker that arouses much interest because it reflects the subclinical inflammation
associated with the degree of diffusion of atherosclerosis in the arterial tree. meta-
analysis of several studies indicates that high sensitivity CRP levels greater than
3 mg / l comprises a coronary accident risk 1.6-fold higher than a rate of
CRP less than 1mg / l. However, despite its strong statistical association with
coronary risk, CRP did not improve the prediction of coronary risk provided
by the Framingham score as the area under the ROC curve does not increase when
is added measuring CRP Framingham score
I agree with the colleague and I believe that the intermediate risk group do CAD is the most important to be screened.
From current evidence, there is no additional benefit of using CRP for low-risk population. The findings of two recent studies suggest no benefit:
A previous meta-analysis concluded that adding CRP improved prediction and risk stratification from intermediate-risk persons.
There are several risk calculators ( Cohort pooled, SCORE, Framingham risk score etc ) to stratify the patients as high,intermediate and low. None of the risk calculators use CRP as a parameter. Additional estimation of hsCRP will help to identify the persons for intermediate risk group ( as Dr, Qadri mentioned) to target.
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