The Clinical Utility of High-Sensitivity C-Reactive Protein in Cardiovascular Disease and the Potential Implication of JUPITER on Current Practice Guidelines

Abstract

Background: High-sensitivity C-reactive protein (hsCRP) testing is relatively inexpensive and has been shown to predict the risk of cardiovascular disease (CVD) and diabetes in multiple patient groups, including those treated with statin therapy. JUPITER (Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin) is a recently completed large multicenter randomized clinical trial that tested whether statin therapy should be given to apparently healthy individuals with lower LDL cholesterol (LDL-C) concentrations but increased hsCRP concentrations. Content: This review discusses the literature on hsCRP in asymptomatic populations, analyzes it according to CVD and diabetes, and provides summary recommendations for the use of hsCRP in clinical practice. In this context, we highlight recent data from the landmark JUPITER trial, which demonstrated that hsCRP can be used to target high-risk patients who have typical LDL-C concentrations and no known vascular disease or diabetes and who would benefit from statin use. We also summarize evidence that among patients treated with statin therapy, achieving low hsCRP concentrations may be a clinically relevant therapeutic goal along with achieving very low LDL-C concentrations. Summary: JUPITER has demonstrated that combining hsCRP testing with traditional testing of lipids can reduce incident CVD in high-risk asymptomatic individuals by 44% and all-cause mortality by approximately 20%, extending the therapeutic use of statins for the primary prevention of CVD. Guidelines for practitioners could include testing asymptomatic individuals for increased concentrations of hsCRP in men ≥50 years and women ≥60 years when LDL-C concentrations are not increased and for whom the decision to treat with statin therapy is not otherwise clear.

Obesity without Established Comorbidities of the Metabolic Syndrome Is Associated with a Proinflammatory and Prothrombotic State, Even before the Onset of Puberty in Children

“…This is similar to previous reports, but many of those children reported previously already showed significant comorbidities, which our subjects did not (9, 31, 35). Polymorphisms of the CRP gene that cause higher CRP concentrations are associated with even greater cardiovascular risk (36), and the administration of statins to individuals with high hsCRP but without dyslipidemia was associated with marked reduction in the incidence of major coronary and neurovascular events in a large cohort of adults (37,38). In this context the increases in IL-6 and hsCRP reported here were remarkable because even the younger prepubertal cohort showed a more than 10-fold elevation in hsCRP concentrations compared with the lean counterparts.…”

“…hsCRP and fibrinogen concentrations have been shown to predict cardiovascular disease in many groups of patients (38) and appear to be more robust analytes than other markers such as IL-6, which has a shorter half-life. CRP itself has been implicated in endothelial dysfunction (46).…”

Is Minimally Invasive Spine Surgery Also Minimally Pro-Inflammatory? Muscular Markers, Inflammatory Parameters and Cytokines to Quantify the Operative Invasiveness Assessment in Spine Fusion

“…To our knowledge, no reports have been published analyzing the peri-operative changes of CRP by using the ultra-sensible method (hsCRP). hsCRP has been introduced in clinical routine as an independent predictor of acute myocardial infarction and cardiovascular death risk (48). hsCRP detection could be an interesting tool to better discriminate the inflammatory pattern between conventional and MIS approaches.…”

Implications of Genetic Polymorphisms in Inflammation-Induced Atherosclerosis

“…Statins, which are primarily advocated as lipid-lowering drug, have been also credited with anti-inflammatory properties [8]. However, clinical trials that are into investigating the long-term benefits of statins such as the JUPITER [9] and PROSPER [10] have shown discrepant findings on the additional value of CRP as a risk predictor in comparison to the prevailing conventional predictors of risk. The outcome of clinical trials is governed by many factors amongst which the design of the trial is a key consideration.…”