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CRP vs. LDL for Predicting Cardiovascular Risk

CRP was a slightly better predictor of first cardiovascular events in these apparently healthy women.

There is persuasive evidence that C-reactive protein (CRP), a marker of inflammation, is associated with cardiovascular disease. In this study, researchers compared the value of CRP levels and LDL-cholesterol levels for predicting cardiovascular risk.

LDL-cholesterol and CRP levels were measured at baseline in about 28,000 apparently healthy women (mean age, 55). During a mean follow-up of 8 years, the CRP level predicted a first cardiovascular event somewhat better than the LDL level did. For example, the relative risk for a first event was 2.3 in the highest quintile of CRP compared with the lowest quintile, after adjustment for other risk factors. With LDL, the corresponding relative risk was 1.5. The probability of event-free survival was about 99% in women whose CRP and LDL levels both were below the population medians, but was only about 96.5% in women whose CRP and LDL levels both were above the population medians. Subgroups with high CRP/low LDL levels and low CRP/high LDL levels had intermediate probabilities of event-free survival.

Comment: The CRP level appears to add predictive information to traditional risk factors for cardiovascular events, presumably because it reflects different aspects of the pathophysiology of atherosclerosis. However, we don't have evidence yet that improved clinical outcomes would result from CRP screening. Thus, an editorialist cautions that "it may be premature to adopt widespread assessment of C-reactive protein."

— Allan S. Brett, MD

Published in Journal Watch General Medicine November 26, 2002

Citation(s):

Ridker PM et al. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002 Nov 14; 347:1557-65.

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Mosca L. C-reactive protein -- To screen or not to screen? N Engl J Med 2002 Nov 14; 347:1615-7.

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