High-Sensitivity C-Reactive Protein: Potential Adjunct for Global Risk Assessment in the Primary Prevention of Cardiovascular Disease
To the Editor:
In his recent article in Circulation, Ridker1 summarizes current evidence indicating the important prognostic value of markers of inflammation, namely C-reactive protein (CRP), in the evolution of cardiovascular disease. The presence of such markers could therefore contribute to a better estimation of the individual risk of patients and an appropriate tailoring of therapy. If the available therapies maintain their value in the relative risk reduction of cardiovascular disease in high-risk patients, the higher absolute risk predicted by CRP or other markers of inflammation would translate to a higher absolute risk reduction in these patients. However, risk estimations should be used not only to predict increased risks but also to preclude unnecessary, expensive, or cumbersome treatments of patients whose evolution is not likely to be improved by these treatments. In this regard, data from previous studies from Ridker may also be read in a divergent manner. Data from the Physician’s Health2 and CARE Studies3 suggest a particular benefit of aspirin and pravastatin, respectively, in patients with markers of ongoing inflammation. On the other hand, the benefits of aspirin and pravastatin were markedly “attenuated and no longer significant” in those patients with lower degrees of inflammation. It seems reasonable to promote the treatment with aspirin and pravastatin in case of increased CRP. Conversely, should we be more reluctant to (or even avoid) the use of aspirin or pravastatin in the presence of low levels of CRP?
Ridker PM. High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Circulation. 2001; 103: 1813–1818.
Ridker PM, Rifai N, Pfeffer MA, et al. Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels: Cholesterol and Recurrent Events (CARE) Investigators. Circulation. 1998; 98: 839–844.