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 . . .
Dr.S.Venkatesan MD 