C-Reactive Protein

[Guest guest]

In an earlier letter today I referred to C-reactive protein (CRP) as another

recently discovered potential indicator of cardiac disease. The following

article and web sites give more information on this topic:

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<http://www.washingtonpost.com/ac2/wp-dyn?pagename=article & node= & contentId=A39

203-2002Nov25 & notFound=true>

Heart Disease Risk and C-reactive Protein

Washington Post

Tuesday, November 26, 2002; Page HE03

One of the most talked-about medical topics of the last couple weeks is

C-reactive protein (CRP), elevated blood levels of which have been closely

tied to heart disease risk. Before you rush out for a CRP test, here are

some things to know:

If my blood cholesterol is normal or lower, what would a CRP test tell me?

Recent studies suggest that an elevated CRP level doubles heart disease and

stroke risk even if you have low cholesterol levels. So a high CRP level

may identify you as one of many people who don't appear to have risk

factors for heart disease, but who may wind up suffering a heart attack

anyway. If a CRP test shows that you're at risk, you can consider changing

your diet and exercise program.

If I have high cholesterol, what would a low CRP test tell me?

First, all people with elevated bad cholesterol -- low-density lipoprotein --

have a high risk of heart disease. If your CRP is low, " you're by no means

home free, " says Ridker, director of Cardiovascular Disease Prevention

at Brigham and Women's Hospital in Boston. " You still need to do something

about lowering your cholesterol. " In other words, the latest evidence on CRP

doesn't change any of the current guidelines about treating high cholesterol.

That remains a very important risk factor for heart disease.

If I have high cholesterol and high CRP, does that place me at greater risk

of heart disease than having either one alone?

Yes, indeed. That's a double whammy, the one that experts say absolutely

cannot be ignored because of the strong potential for health peril.

If I were found to have a high CRP level, what would I do to lower it?

The exact same things used to lower blood cholesterol levels: Eat a healthy,

well-balanced diet low in saturated fat and high in fruit, vegetables and

whole grains. Achieve a healthy weight, since obesity seems to increase CRP

levels. Get plenty of regular exercise. In the future, drug therapy may help

some people, too. Studies suggest that cholesterol-lowering statin drugs also

reduce CRP levels, and there's evidence that aspirin may be particularly

beneficial to those with elevated CRP levels. What isn't known yet is

whether lowering CRP levels reduces heart attacks and deaths. Those studies

have not yet been done, but a large trial involving 15,000 people is set to

begin in January to help answer that question.

If my doctor or insurer won't authorize a test, can I get my CRP tested on my

own?

Absolutely. The test has been available for 65 years -- yes, you read that

right -- and generally runs about $15 to $18, although some labs have been

known to charge as much as $150. It's available at most standard outpatient

laboratories. The only thing you have to be prepared to do is roll up your

sleeve, since it's a blood test........

More information is available from:

* the American Heart Association (www.americanheart.org)

* the National Heart, Lung, and Blood Institute (www.nhlbi.nih.gov).

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FURTHER INFORMATION

<http://www.drdebe.com/Creactpr.htm>

C-reactive protein is a marker of inflammation measured from blood samples.

When C-reactive protein is found to be above normal levels, an attempt should

be made to determine the underlying cause of the inflammation. It appears

that one cause is infection with bacteria or viruses. Helicobacter pylori,

chlamydia pneumoniae, Epstein-Barr virus, and Herpes simplex virus are some

of the possible causative organisms. Exposures to toxins and antigens,

including food allergens, is another cause of inflammation. Smoking

cessation, dietary modification and natural supplements can all help reduce

inflammation.

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<http://www.heart1.com/news/mainstory.cfm/66/1>

C-Reactive Protein Surpasses LDL in Predicting Cardiovascular Disease

Nov21, 2002

By Ross, Heart1 Staff

[Excerpts given....]

The connection between elevated levels of C-reactive protein (CRP) and

coronary heart disease has long been acknowledged in the scientific

community. Stirring up a storm among heart professionals however, is the

recent finding by Dr. Ridker and colleagues that CRP levels are

actually superior to LDL cholesterol in predicting cardiovascular events.

Moreover, the two factors seem to be unrelated, meaning there may be a whole

new way to control the risk of heart disease........

The identification of CRP as such an important predictor of cardiovascular

events could potentially explain why as many as half of all heart attacks

occur in individuals with normal cholesterol levels.

In Ridker's investigation, for example, 77% of adverse events struck

subjects with LDL levels below 160 mg/dL, while 46% had levels even below 130

mg/dL. As a point of reference, the American Heart Association considers LDL

levels of less than 100 mg/dL " optimal, " while only levels above 160 mg/dL

are believed " high. "

Although the CRP findings will doubtless impact the future of preventative

heart disease treatments, the old LDL standards will by no means be

abandoned. Indeed, as Ridker writes, " C-reactive protein and LDL cholesterol

measurements tended to identify different high-risk groups, [and] screening

for bothâ€| provided better prognostic information than screening for either

alone. "

So what exactly is this new diagnostic weapon? CRP is secreted by the liver

in response to inflammatory events throughout the human body. It is

believed likely that CRP plays a role in coronary heart disease because many

cardiovascular problems, such as atherosclerosis (where fatty deposits

accumulate in artery linings), have a significant inflammatory component.

In fact, an earlier 1997 Ridker publication revealed that the reduction in

risk of a first myocardial infarction associated with aspirin was directly

related to CRP levels. Such results may indicate a possible role for

anti-inflammatory drugs in preventing cardiovascular disease. Other studies

have further indicated that statins, which are commonly used to lower LDL

levels, have the additional and independent effect of reducing coronary heart

disease risk in people with high CRP.

It is difficult to estimate the full future impact of this development for

cardiovascular medicine. In addition, the effects are unlikely to be

contained to one field, as results indicating that CRP levels are elevated

from hormone replacement therapy, for example, gain new significance. The

American Heart Association and Centers for Disease Control and Prevention

plan to publish recommendations regarding whether physicians should routinely

include CRP tests to monitor heart disease risk. For certain, it is clear

that C-reactive protein has permanently joined the ranks of LDL, HDL, blood

pressure and others as an important health standard.

Sources:

* New England Journal of Medicine 2002 Nov 14;347(20):1557-65

* http://www.nhlbi.nih.gov/about/framingham/riskabs.htm

* http://www.health.harvard.edu/fhg/Darchive/diseases.701.shtml

* New England Journal of Medicine 1997 Apr 3;336(14):973-9

* Journal of American Medical Association 2002 Aug 28;288(8):980-7

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Dr Mel C Siff

Denver, USA

http://groups.yahoo.com/group/Supertraining/

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