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Healthier World with Quest Diagnostics
30 - Instant insights: hs-CRP in cardiovascular risk (7 min)
00:07:19
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Foreign welcome to Healthier World with Quest Diagnostics. Our goal is to prompt action from Insight as we keep you up to date on current clinical and diagnostic topics in cardiovascular, metabolic, endocrine and wellness medicine. Recent evidence shows that most cardiovascular events don't happen simply because arteries slowly narrow over time. Instead, they occur from soft, unstable plaque rupture, triggering an intense inflammatory cascade and ultimately a blood clot. Let's think about it this way. We can draw a parallel between soft plaque and volcanoes. Soft, sticky plaque is made up of cholesterol and fat, and it can erupt just like a volcano and lead to a heart attack or a stroke. And the fuel for that volcano, the most common thing that makes a plaque vulnerable for rupture is is inflammation. I'm Dr. Mason Latsko and today we're going to deep dive into one of the most commonly utilized inflammatory biomarkers to identify cardiovascular risk, hscrp. Now, some listeners have heard of C Reactive protein, which is a nonspecific acute phase protein produced by the liver in response to injury, infection and inflammation. And CRP levels can raise as much as 1000 fold after an acute event. And in fact, CRP levels up to 50 milligrams per liter are commonly associated with viral infection or injury. Whereas after a severe infection like major traumas or sepsis, we can see CRP levels raised to about 300 milligrams per liter or even higher. And these high levels of CRP can be used to diagnose and monitor acute phase inflammatory states. But levels of CRP between 1 and 10 milligrams per liter indicate chronic mild elevations in CRP that can indicate cardiovascular disease. Now, looking at lower levels of CRP requires a specific assay, and that's where high sensitivity CRP or HSCRP comes in. HSCRP can accurately determine CRP levels in a lower range below 10 milligrams per liter. Patients with HSCRP levels below 1 milligram per liter is considered low cardiovascular risk, while 1 to 3.3milligrams per liter is considered moderately increased risk for cardiovascular disease. And any patient with an HSCRP level between 3 milligrams per liter and 10 milligrams per liter are considered at high cardiovascular risk. So to emphasize the difference one more time in CRP in response to an illness or injury, we can think about this like a bonfire. We see a large spike in CRP that burns very quickly and briefly over a short period of time, approximately a few days or weeks. HSCRP can be thought of more like a candle, it's not as big of a burst of a flame, but it can stay burning for much longer. And when we're thinking about chronic low levels of HSCRP elevation indicating cardiovascular risk, we're thinking about this elevation over months to years. And this is really when it indicates plaque burden and presence of atherosclerosis in your arteries. So if you get an HS CRP and it is elevated, you want to get it repeated about two weeks later to make sure that the elevation that you're seeing isn't due to an acute event like illness or injury. When we're thinking about HSCRP indicating cardiovascular risk, we're really thinking about that chronic low grade elevation between 1 mg per liter and 10 mg per liter. An elevated HSCRP has been consistently associated with an increased relative risk of future cardiovascular events, including myocardial infarction, stroke and cardiovascular death. One of the most influential studies in this space is called the Jupiter Trial, which demonstrated that statin therapy significantly reduces the risk of heart attack, stroke and death in patients with elevated hscrp even when LDL cholesterol levels were not elevated to begin with. And this shifts the conversation from cholesterol alone to inflammation as a therapeutic target for patients at risk for cardiovascular disease. Another influential study called the Cantos trial looked at the influence of lowering inflammation and specifically HSCRP even in the absence of LDL changes, and they observed a 15% risk reduction in reoccurring cardiovascular events even in patients without a change in LDL cholesterol. In other words, cardiovascular risk went down with a decrease in hscrp even though lipids stayed the same. And this really solidified that targeting and lowering inflammation lowers risk. Additional data has continued to reinforce this concept. Large scale trials have identified HSCRP as a strong predictor of major cardiovascular events, cardiovascular mortality and even all cause mortality. Because of this robust evidence, HSCRP has now been integrated into cardiovascular prevention guidelines. For example, the AHA and the ACC consider elevated HSCRP above 2 milligrams per liter to be a risk enhancer and recommend risk Discussion Regarding moderate intensity statin therapy when a patient has ASCVD risk that reaches borderline or intermediate levels in conjunction with elevated hscrp. And it's important to recognize that HSCRP isn't elevated in isolation. In fact, it's commonly associated with with many conditions that we speak about here on healthier world, including increased weight, elevated blood pressure, cigarette smoking, metabolic syndrome, diabetes, low HDL cholesterol, high triglycerides hormone therapy, and even chronic infections or inflammatory conditions. So these scenarios may increase your patient's risk for having high hscrp, which ultimately leaves them at greater risk of having a cardiovascular event. And not only has HSCRP gained attention in medical guidelines, but it's also a very popular topic in wellness medicine. There's an emerging concept known as inflammaging, which describes low level inflammatory states that develop with age and is accelerated by poor lifestyle. HSCRP can serve as a measurable signal for this inflammaging process, and it's a reminder that cardiovascular disease is not just a lipid disorder. HSCRP can be used as a red flag and paired with other inflammatory biomarkers like MPO and LPPLE2 to improve risk stratification and identify patients who are at greatest risk. Understanding and addressing inflammation may be one of the most empowering and important tools that we have in our toolkit, allowing us to quiet the plaque before the volcano erupts. That's a wrap on this episode of Healthier World with Quest Diagnostics. Please follow us on your favorite podcast app and be sure to check out Quest Diagnostics Clinical Education center for more resources, including educational webinars and research publications. Thank you for joining us today as we work to create a healthier world, one life at a time.