Dr.S.Venkatesan MD

What we know about CRP . . .

• It is an acute phase reactant.
• Secreted mainly in liver.
• It is a marker for systemic inflammation.
• Hs CRP more than 1 -3 mg is significant

What we think ,  we know . . .

It is a direct marker for increased risk of CAD.

Reducing CRP levels reduce CAD risk  and vice versa .

What we definitely do not know . . .

Does CRP damage the coronary  endothelium ?  Or  Is it secreted  from the inflamed plaque ?

How statins reduce CRP ?

How can you differentiate cardiac origin of CRP from peripheral origin ?

Fibrinogen levels  tend to raise in non cardiac CRP elevation .

What are  the commercial interest in this molecular test   ?

Hs CRP is  being proposed  as a screening test  for  detecting high risk CAD ,   to enable it  for  mass marketing . For drug companies  developing a  drug is huge task as  tight regulations  are vigorously pursued. While getting  clearance for  a   biochemical   investigation   is  a much easier task,  as it does not involve  patient safety or  ethical issues .

So, one of  the major studies  on statins  ,  suggested   a major role ,  for  estimation  of  Hs CRP  to identify high risk subsets among  those with normal LDL levels.  This study  many academicians felt,  was  aimed to promote  this investigation .  Care takers  should be aware  of the motives behind  the so called  global war against CAD . Many such  interventions could be  entirely commercial . This is a dangerous trend  ,  the medical profession  is facing .  It could  be more damaging than the ubiquitous atherosclerosis !

What we should know ?

Final message

• C reactive protein is  nothing more than a  new generation ESR !
• It  may  not have any specific value in a given individual to predict / not predict  a cardiac  event  .
• The only role could be to identify  subset of  population who may be at higher risk of developing inflammatory  CAD.
• But it  is largely a hype ,  to call it as a landmark  triaging  molecule  for  preventing  CAD is not acceptable to many.
• The meta analysis  on CRP in Lancet  2010  was published  . I am afraid ,  it has not answered the elusive question  : What is the utility value of Hs CRP in the  clinical cardiology and preventive cardiology  ?

What we need to know is ,

• Avoiding  junk  food,
• Good physical activity,
• Quitting smoke ,
• And  a relaxed mind  (All of them come free of cost ! The first one , in fact  pays you !)

Is the best way to prevent CAD epidemic !

One need not go behind this fancy molecule  . . .