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A new blood test may help determine heart disease risk even in those
patients who have healthy cholesterol levels, according to researchers. The new "high
sensitivity CRP" test detects a protein called C-reactive (CRP), which is produced in
the liver and indicates when arteries are inflamed. From a C-reactive protein study of
more than 20,000 healthy post-menopausal women, researchers say the CRP test can help
predict a first heart attack.
According to researcher Dr. Paul Ridker, associate professor of medicine at Harvard
School of Medicine, women with elevated CRP levels are four times as likely to have heart
attacks compared with women who have low CRP levels. Dr. Ridker and researchers studied 12
separate markers for heart attacks, including high cholesterol levels, cigarette smoking,
diabetes, and obesity. CRP was the single strongest predictor of a heart attack, said Dr.
Ridker.
If physicians were to begin widespread use of the CRP test, it would serve as a
supplement to cholesterol tests and other preventive measures (such as low-fat diet,
exercise, no smoking). The CRP test was approved by the U.S. Food and Drug Administration
(FDA) in November 1999. Emerging research on CRP has caused researchers to re-think their
theories about how heart attacks occur. Researchers now believe that while high
cholesterol causes hardened fatty build-up, heart attacks occur when inflamed arteries
cause chunks of fatty deposits to break off and clog an artery.
Physicians and heart specialists are optimistic about the effectiveness of the CRP
test. Former American Heart Association president Dr. Sidney Smith says other research
shows CRP levels help prevent a second heart attack (since patients who know they have
high CRP levels are more likely to take preventive measures to reduce their chances of a
heart attack). Jonathan Abrams, MD, an expert in heart disease prevention called the study
a "blockbuster." William O’Neill, MD, director of cardiology at William
Beaumont Hospital in Detroit, Michigan believes the CRP test will help physicians identify
30% to 50% of first heart attack victims who do not otherwise seem to be at significant
risk for heart disease. The average cost of a CRP test is around $20.
If patients are found to have high CRP levels, physicians recommend exercising,
lowering blood pressure, losing weight, maintaining a healthy diet, and not smoking.
Cholesterol-lowering drugs called statins may also help fight artery inflammation, but
researchers are still uncertain whether lowering cholesterol will lower CRP.
A few physicians would like to see further research before the CRP test gets too much
publicity. Dr. Daniel G. Blanchard, a cardiologist at the University of California at San
Diego Medical Center says he would like to see additional studies which confirm the
effectiveness of the CRP test. Dr. Ridker’s study included only women, but
researchers believe the CRP test would also be effective in men. Women, who have
traditionally been excluded from cardiac research, are more likely to die of heart disease
than breast cancer and all other cancers combined.
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