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Posts Tagged ‘crp’

C reactive protein : Old wine in “older bottle” !

Posted in Uncategorized, tagged , , , , , , , , , on October 20, 2010| Leave a Comment »

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  . . .

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Conquering atherosclerosis : Why we are not getting the desired outcome ?

Posted in Uncategorized, tagged , , , , , , , , , , , , , on November 29, 2009| Leave a Comment »

Atherosclerosis   remains the number one cause for all vascular disease of human beings. It probably  kills more  patients than all other causes put together .

Modern medicine has never conquered the disease. How  the vascular system ages and why some develop premature atherosclerosis remains largely speculative. While it is true , we have identified some major risk factor for development and progression of the atherosclerosis  , patients with out any of those risk factors do develop severe atherosclerosis !So researchers sought to look for some other risk factors . There lies the difficulty  and irony .

We always tend to the research with the affected population .When we know millions of people with the so called risk factors live comfortably , there lies an opportunity  to  analyse why they are protected against the onslaught of atherosclerosis .It is always convenient to blame it or bless it on the genetic predisposition .But we need to look beyond that .Of course  . every genetic expression has to  manifest phenotypically .

While the search for all those hidden secrets has to continue , we should also realize in pursuit of breakthrough we some times waste our energy in false targets  for too many decades !

The reality as on today is ,  there is no reliable  &  undisputed drug available to arrest atherosclerosis  (Some would love to call statin so . . . )

While  our basic science colleagues struggle  in molecular  factories and biological models in pursuit of answer against  atherosclerosis , our elite  cardiac physicians   carry on with the cosmetic touches over this   progressive disease  in  sophisticated cath labs.

Let us hope  man prevails over nature . . .

A cartoon , Just for laughs . . .

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