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Clinical Chemistry 52: 1254-1256, 2006; 10.1373/clinchem.2006.070904
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(Clinical Chemistry. 2006;52:1254-1256.)
© 2006 American Association for Clinical Chemistry, Inc.

Point/Counterpoint

Point: High-Sensitivity C-Reactive Protein and Cardiac C-Reactive Protein Assays: Is There a Need to Differentiate?

Nader Rifai1,a, Christie M. Ballantyne2, Mary Cushman3, Daniel Levy4,1 and Gary L. Myers5,1

1 Children’s Hospital and Harvard Medical School, Boston, MA.
2 Baylor College of Medicine, Houston TX.
3 University of Vermont, Burlington, VT.
4 Framingham Heart Study, Framingham, MA.
5 Centers for Disease Control and Prevention, Atlanta, GA.

aAddress correspondence to this author at: Department of Laboratory Medicine, Children’s Hospital, 300 Longwood Ave., Boston, MA 02115. Fax 617-730-0383; e-mail nader.rifai@childrens.harvard.edu.

The first 20% of the full text of this article appears below.

Recent evidence has shown that inflammation plays a pivotal role in the inception and progression of atherosclerosis, and population studies have demonstrated a strong and independent association between baseline concentrations of inflammatory biomarkers and future coronary events. Because the majority of individuals who develop coronary events are not in a high-risk group according to the Framingham risk assessment of traditional risk factors for coronary heart disease (CHD),2 and because one half of those who suffer myocardial infarctions have normal lipid values, measurement of inflammatory markers has been suggested as an adjunct to lipid testing to better identify individuals at increased risk (1). Of the inflammatory markers evaluated by a CDC and American Heart Association (AHA) Panel in 2002(2)(3), only C-reactive protein (CRP) met the analytical requirements for outpatient clinical use and, therefore, has been studied intensely over the past decade.

More than 25 prospective epidemiologic studies have shown that CRP is a strong and independent predictor of future myocardial infarction, ischemic stroke, peripheral arterial disease, and sudden cardiac death in apparently healthy men and women (4). Furthermore, 9 studies to date have demonstrated that CRP provides additional prognostic value to the Framingham Risk Score(4). Guidelines regarding the potential usefulness of CRP in primary and secondary prevention settings have been issued by the CDC and AHA(2). Physicians have become accustomed to use of the "high-sensitivity CRP (hsCRP)" terminology when considering measurement of CRP for vascular disease risk stratification, as opposed to the use of . . . [Full Text of this Article]






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