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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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International Angiology 2003 March;22(1):15-23


lingua: Inglese

High sensitivity C-reactive proteein in cardiovascular risk assessment. CRP mania or useful screening?

Sellmayer A. 1, 2, Limmert T. 1, Hoffmann U. 2

1 Division of Cardiology, Medical Polyclinic, University Hospital of Munich, Munich, Germany 2 Division of Angiology, Medical Polyclinic, University Hospital of Munich, Munich, Germany


Ele­vat­ed level of the acute phase reac­tant C-reac­tive pro­tein (CRP) is a very sen­si­tive mark­er of acute inflam­ma­to­ry reac­tions. Using high sen­si­tiv­ity ­assays for CRP, ­recent obser­va­tions indi­cate that slight­ly ele­vat­ed CRP lev­els which would be in the nor­mal range of con­ven­tion­al ­assays are a novel mark­er for an ­increased risk for car­di­o­vas­cu­lar ­events, espe­cial­ly cor­o­nary ­artery dis­ease and myo­car­dial infarc­tion. Var­i­ous large scale pros­pec­tive ­trials includ­ing the ­Physicians’ ­Health Study and the ­Women’s ­Health Study ­revealed that slight­ly ­increased hsCRP lev­els at base line in appar­ent­ly ­healthy per­sons are asso­ciat­ed with a 2-fold ­increase in the risk of a ­future myo­car­dial infarc­tion. The pre­dic­tive value of hsCRP was found to be inde­pen­dent from clas­sic risk fac­tors, in par­tic­u­lar from ele­vat­ed serum cho­les­te­rol. An ­increase in hsCRP lev­els was also asso­ciat­ed with a high­er risk to devel­op periph­er­al ­artery dis­ease and with a fast­er pro­gres­sion of carot­id ­artery dis­ease. Until now, treat­ment with HMG-CoA reduc­tase inhib­i­tors (sta­tins) has been found to be the only med­i­ca­tion to con­sis­tent­ly ­decrease hsCRP lev­els, ­although by about 15% only. ­Despite the asso­ci­a­tion of ele­vat­ed hsCRP lev­els with ­future car­di­o­vas­cu­lar ­events, rou­tine meas­ure­ment of hsCRP for car­di­o­vas­cu­lar risk assess­ment is cur­rent­ly not rec­om­mend­ed ­because of its low accu­ra­cy, the lack of a clear cut-off point for ele­vat­ed hsCRP lev­els and the lack of an abso­lute pre­dic­tive value. So far, hsCRP ­remains an inter­est­ing poten­tial risk mark­er for car­di­o­vas­cu­lar dis­ease whose def­i­nite rel­e­vance ­remains to be estab­lished.

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