BWH Study Reaffirms Importance of CRP Testing to Predict Heart Attack Risk
Study finds best overall strategy is to combine CRP with total and HDL cholesterol;non-HDL-cholesterol also found to be a strong predictor of risk
BOSTON – Researchers from Brigham and Women’s Hospital (BWH), in a landmark study from 2002, found that CRP – or C-reactive protein – was a more powerful predictor of a person’s risk of suffering a heart attack or stroke than screening based on LDL cholesterol. Now, BWH researchers have found that high-sensitivity CRP is a more powerful predictor than any individual lipid marker for heart disease including non-HDL-cholesterol and apolipoproteins (cholesterol carrying molecules) A-1 and B100. However, the new data also supports the role of non-HDL-cholesterol (total cholesterol minus HDL cholesterol) as an important marker for heart disease risk. These findings will be published in the July 20, 2005 issue of the Journal of the American Medical Association.
Half of all heart attacks and strokes occur among individuals with normal cholesterol levels. Research done to date on the efficacy of CRP, including several important studies conducted at BWH, have found that CRP – an inflammation biomarker – independently helps predict disease. To better predict and prevent heart attacks, many clinicians now recommend that in addition to regular cholesterol checks, monitoring and managing CRP should be an integral part of the healthcare regimen for those at “intermediate risk” – a strategy endorsed by the Centers for Disease Control and the American Heart Association.
According to the study’s lead author, Paul M. Ridker, MD, a cardiologist at BWH, “Measuring and lowering cholesterol remains an absolutely crucial part of our strategy to fight heart disease, but cholesterol is only part of the problem. We now have more evidence that supports the addition of CRP to better predict heart attack risk, regardless of underlying cholesterol levels.”
This study focused on 15,632 participants in BWH’s Women’s Health Study aged 45 years and older who were followed for 10 years and monitored for the occurrence of a first cardiovascular event. Among the women studied, 464 developed a first-ever confirmed cardiovascular end-point, which included heart attack, ischemic stroke, coronary revascularization and coronary death. After adjustment for age, smoking status, blood pressure, diabetes and body mass index researchers found that while all lipid measurements helped predict risk, CRP was stronger. For example, while those with the highest levels of cholesterol had twice the risk of future heart disease and those with the highest levels of non-HDL-cholesterol had a 2.5 increase in risk, the research demonstrated that women with the highest levels of CRP had a three-fold increase in risk. In addition, based on predictive power, researchers found that standard lipid measures – in particular the ratio of total cholesterol to HDL cholesterol – should be used for primary risk detection as opposed to more complex lipids such as apolipoproteins A-1 and B100.
“The new data not only reaffirms the use of CRP as an additional method to predict heart disease and stroke risk, but they also show that routine lipid measures such as total and HDL cholesterol do an excellent job picking up the lipid component of risk,” said Ridker, who is also the Eugene Braunwald Professor of Medicine at Harvard Medical School. “The best strategy overall was clearly to combine information obtained from all three of these important markers of risk.”
Please contact BWH Media Relations for more information at (617) 534-1600 or BWHMediaRelations@partners.org.
BWH is a 747-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare System, an integrated health care delivery network. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832 and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives, dedication to educating and training health care professionals, and strength in biomedical research. With $370M in funding and more than 500 research scientists, BWH is an acclaimed leader in clinical, basic and epidemiological investigation - including the landmark Nurses Health Study, Physicians Health Studies, and the Women's Health Initiative. For more information visit www.brighamandwomens.org
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