Abstract 18697: C-Reactive Protein Performance as a First-Line Biomarker for Cardiovascular Risk Assessment Among Healthy Women

Abstract

Background: Over 20% of coronary events in women occur in the absence of traditional cardiovascular risk factors. Framingham Risk Score (FRS) limitations in assessing cardiovascular risk in this group are well known. C-Reactive Protein (hs-CRP) has been shown to correctly reclassify cardiovascular risk among women, more specifically among those ones initially categorized as at intermediate risk by FRS. However, evidence supporting hs-CRP use as a first-line test in clinical practice is lacking. We assessed hs-CRP performance in cardiovascular risk re-classification among healthy women routinely attended at a preventive medicine unit.

Methods: We evaluated 1.455 consecutive asymptomatic non-diabetic women (mean age: 42 ± 7.9 years) submitted to a routine health evaluation. As part of the evaluation, FRS, hs-CRP levels and Reynolds Score were assessed.Two different models were set to re-classify cardiovascular risk initially estimated by FRS: the first one (Model A) established hs-CRP levels >3<10mg/dL as a cut-off to switch women from FRS “intermediate risk” to the “high risk” category; the second one (Model B) re-stratified cardiovascular risk using Reynolds Score. We studied the performance of both models in cardiovascular risk re-classification.

Results: Cardiovascular risk estimated by FRS was low in 98.6% (N=1,435) of the study population; intermediate in 1.1% (N=16); and high in 0.3% (N=4). Hs-CRP >3<10 mg/dL was found in 197 women (13.5%). Among those with high hs-CRP levels, 196 (99,5%) presented low FRS and 1 (0,5%) intermediate FRS. Model A led to risk re-classification of one woman in 1,455 (0.07%). Reynolds score was highly concordant with FRS (p<0.001), so that Model B did not significantly improve hs-CRP performance.

Conclusion: Routine measurement of hs-CRP levels has minimal impact on cardiovascular risk re-classification of healthy women in clinical practice, due to the very low average cardiovascular risk of such population. Check-up protocols should not measure hs-CRP routinely in women and leave this determination as a second-line test for cardiovascular risk assessment in specific groups of individuals.