Received on November 10, 2008
Accepted on November 12, 2008

Mini-Review

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

¹ Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
² The Johns Hopkins Ciccarone Preventive Cardiology Center, The Johns Hopkins University School of Medicine, Baltimore, MD

^* To whom correspondence should be addressed. E-mail: smora{at}partners.org.

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 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.