The high-sensitivity C-reactive protein (hsCRP) assay is a quantitative analysis test of very low levels of C-reactive protein (CRP) in the blood. The hsCRP assay is being increasingly used as a marker for cardiac risk assessment and as a prognostic tool in heart disease. The CRP test, in addition to lipid evaluation and global risk scoring systems, helps in the evaluation of cardiovascular disease risk in an individual.

C-reactive protein is an acute phase protein that appears in circulation in response to inflammatory cytokines, such as interleukin-6, and serves as a biomarker for systemic inflammation.¹

Background

Following a systematic review of the association between inflammatory markers and coronary heart disease and stroke, the American Heart Association (AHA) and Centers for Disease Control and Prevention (CDC) developed a scientific statement that recommends hsCRP as a more sensitive assay for the prediction of vascular disease, compared to traditional assays for circulating C-reactive protein levels. ^2,3

The AHA/CDC Scientific Statement Summary^2,3

• hsCRP is a global indicator of future vascular events in adults without any previous history of cardiovascular disease (CVD), with acceptable precision levels down to or below 0.3 mg/L
• hsCRP enhances risk assessment and therapeutic outcomes in primary CVD prevention
• hsCRP is particularly advantageous for assessing the risk in patients with
  • Framingham 10-year risk scores of 10%-20% and/or
  • LDL levels of <160 mg/dL
• hsCRP acts as an independent marker for evaluating the possibility of recurrent cardiac events, such as myocardial infarction or restenosis, after percutaneous coronary intervention

Clinical Applications

hsCRP in Atherosclerosis and Plaque Instability/Inflammation

With the recognition of the crucial link between arterial damage, inflammatory processes, and coronary atherosclerosis, hsCRP estimation has assumed a vital role in cardiac risk assessment. C-reactive protein is an important pathogenic factor for atherosclerosis and induces several reactions involved in atherothrombogenesis:

• Activates complement and attacks monocytes
• Incites endothelial dysfunction
• Augments a procoagulant state
• Contributes to plaque instability/rupture

hsCRP in Risk Stratification and Risk Assessment

hsCRP levels help in cardiac risk stratification and assessment, and it are a key prognostic factor in conditions such as:³

• Acute coronary syndrome (ACS)
• Stroke
• Peripheral artery disease (PAD)
• Post-MI complications such as cardiac failure⁴

AHA/CDC risk assessment guidelines

Sensitivity for Cardiovascular Applications