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Do Traditional CHD Risk Factors Explain CRP Elevations?

Data from the Third National Health and Nutrition Examination Survey suggest yes.

Elevated C-reactive protein (CRP) levels have been associated with risk for coronary heart disease (CHD), but to what extent are such elevations attributable to the presence of traditional CHD risk factors? Researchers addressed this question by analyzing data from the Third National Health and Nutrition Examination Survey (1988–1994) on an array of traditional CHD risk factors and CRP levels.

In age- and race-adjusted analyses, obesity, hypertension, female sex, diabetes, cigarette smoking, and low HDL-cholesterol levels were the traditional CHD risk factors most strongly associated with elevated CRP levels (>3.0 mg/L). The presence of one or more abnormal traditional CHD risk factors accounted for most of the risk for CRP elevation (73% in men, 65% in women); borderline traditional CHD risk factors added another 5% and 2%, respectively, of attributable risk.

Comment: These data suggest that CRP elevation, though an important marker of inflammation, may add little clinically to information from traditional CHD risk factors. The authors and an editorialist concur with the current CDC/AHA recommendation that CRP measurements be reserved for patients at intermediate risk for CHD. Clinicians should remain focused on modifying traditional CHD risk factors, where the greatest weight of evidence has been associated with improved outcomes.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology November 11, 2005

Citation(s):

Miller M et al. High attributable risk of elevated C-reactive protein level to conventional coronary heart disease risk factors: The Third National Health and Nutrition Examination Survey. Arch Intern Med 2005 Oct 10; 165:2063-8.

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• Medline abstract (Free)

Tracy RP and Kuller LH. C-reactive protein, heart disease risk, and the popular media. Arch Intern Med 2005 Oct 10; 165:2058-60.

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• Medline abstract (Free)