What To Do When Your CRP Is High

OK, Your CRP Level is High. Now What?

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Has your doctor measured your C-reactive protein (CRP) level, and found it to be elevated? This is an increasingly common situation, despite the fact that most experts do not recommend routinely measuring CRP levels.

Now What?

It is likely that you may be puzzled, or even alarmed, by finding that your CRP is high. Unfortunately, it is reasonably likely that your doctor is also puzzled about what to do next — since "what to do next" is not entirely straightforward.

While it is now well established that inflammation is an important contributor to atherosclerosis, and that elevated CRP (which is a marker for inflammation) is associated with an increased risk of coronary artery disease (CAD), it is unknown whether CRP itself helps to cause CAD, or whethe treatment aimed specifically at lowering CRP levels reduces cardiovascular risk.

So, when your CRP is high your risk of developing CAD is also higher than it ought to be. But we don’t really know how much it really helps to take steps aimed specifically at reducing your CRP levels. Rather, what needs to be done is to take every opportunity you have to reduce your overall cardiovascular risk.

What Should Happen Next

Now that you know your CRP is high, there are two questions you should be asking.

1) What are my other risk factors?

Elevated CRP levels are almost always associated with other risk factors for heart disease.

These include smoking, obesity, sedentary lifestyle, increased cholesterolhypertension and metabolic syndrome. All of these risk factors are extremely important, and you and your doctor have the ability to get all of them under control.

So, whatever you and your doctor may decide to do about the CRP itself, having an elevated CRP makes it even more important to take aggressive measures to reduce all your cardiac risk factors.

2) How can I reduce my CRP level?

While it is still uncertain how important it is to reduce an elevated CRP level itself, several ways of reducing CRP have been identified:

Non-pharmacological methods of reducing CRP include aerobic exercisesmoking cessationweight loss and a heart-healthy diet. In other words, taking aggressive steps to make your lifestyle healthier will also result in a reduced CRP level.

Drug therapy can also reduce CRPStatins reduce CRP levels significantly (13 to 50%,) according to several clinical trials. Lipitor (atorvastatin), Mevacor (lovastatin), Pravachol (pravastatin), Crestor (rosuvastatin) and Zocor (simvastatin) have all been proven to bring down CRP levels and have shown evidence of reducing cardiac risk through CRP (as opposed to cholesterol) reduction. Also, the JUPITER trial showed definitively that in patients with high CRP levels but "normal" cholesterol levels, Crestor significantly and substantially reduced cardiovascular risk.

While aspirin does not reduce CRP levels, people with elevated CRP levels gain more risk-reduction benefit from aspirin than those with normal CRP levels. So elevated CRP levels may tip the scales in favor of prophylactic aspirin therapy for some.

 Read more about who should take prophylactic aspirin.

The Bottom Line

It remains unknown whether CRP itself increases cardiovascular risk, or whether it merely reflects the vascular injury and inflammation that results from other risk factors. So if your CRP levels are elevated, you should take that as an important sign that it is time to get serious about reducing all your cardiac risk factors by exercising, not smoking, losing weight, watching your diet, and controlling your blood pressure.

However, it now appears clear that the use of statin drugs can substantially reduce the risk of heart attack and stroke in even healthy-appearing patients whose CRP levels are high.

If you have high CRP levels, especially if you have one or more additional risk factors for heart disease, you should discuss the option of taking a statin drug with your doctor.

Sources:

Emerging Risk Factors Collaboration, Kaptoge S, Di Angelantonio E, et al. C-reactive Protein Concentration and Risk of Coronary Heart Disease, Stroke, and Mortality: an Individual Participant Meta-analysis. Lancet 2010; 375:132.

Ridker PM, Danielson E, Fonseca FA et al. Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-reactive Protein. New Engl J Med 2008; DOI: 10.1056/NEJMoa0807646. 

Sever PS, Poulter NR, Chang CL, et al. Evaluation of C-reactive Protein Prior to and On-treatment as a Predictor of Benefit from Atorvastatin: Observations from the Anglo-Scandinavian Cardiac Outcomes Trial. Eur Heart J 2012; 33:486.

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