CARDIOVASCULAR SCREENING THROUGH CRP

C-reactive protein (CRP) has been for long associated to cardiovascular diseases, so often studies are performed to verify its usefulness in the evaluation of cardiovascular risk. Two new studies examined the problem. In the first one, to verify whether it is possible to perform tests being able, in a sufficiently precise way, to give a prevision of cardiovascular disease, some researchers have followed 15048 women (average age more than 45)for about 10 years; 390 of them developed a cardiovascular disease during follow-up. When, to the usual risk factors (cholesterol, smoke, hypertension, age) also CRP was added, predictivity was not improved. The four traditional risk categories were then considered (<5%, 5%-10%, 10%-20%, >20%), recalculated according to RCP values. In this way, about 13% of women in each category were reclassified in the category, but 2%-10% were transferred into a higher category.
Authors affirm that the use of CRP would be a danger, as it could undermine preventive interventions, creating false normality situations. In a second prospective study, realized in USA, researchers evaluated the effects of the adding of CRP dosage (and of other 18 exams) to traditional cardiovascular risk factors (age, sex, race, total cholesterol and HFL, systolic pressure, use of anti-hypertension drugs, diabetes mellitus, smoke). 16000 adults over 45 were examined and it was found a significant predictive improvement only through the determination of phospholipase A2, even if that improvement represented no clinical advantage.

The discussion on the predictive usefulness of CRP and other tests is doomed to continue. Probably, CRP can give some more indications, but it is necessary to consider that the only possibility to keep cardiovascular risk low is to intervene on traditional risk factors, as the lowering of CRP is not accompanied by an improvement of individual risk. Remembering that only one person with hypertension out of three reaches an adequate control, leader writers affirm that CRP dosage screening is not proposable at the moment.