C Reactive Protein - CRP - Cardiac Disease and Stroke

In early November 2008 there was an interesting article in the New York Times which covered the JUPITER trial, a large study that investigated whether treating patients with elevated CRP levels, but normal cholesterol levels, with low doses of a statin medication, could reduce their likelihood of suffering symptoms of heart disease, such as heart attacks, and strokes. The results were so clear that the trial was stopped much earlier than its planned end date.

The answer: Yes, treating these patients with statins prevented heart attacks and strokes. The real question is whether this finding has a practical meaning for the health care system as a whole. In other words, do these findings obligate doctors to routinely test people who have a low risk of cardiovascular disease for CRP. And if CRP is elevated, should doctors go on to prescribe statin treatment?

Many believe the answer is yes, but I think the answer is no. Even though the study showed a significant reduction of heart attacks and strokes in people with elevated CRP levels in their blood, the actual numbers of people affected was a bit too small to warrant doctors to implement the study’s conclusions into clinical practice. What’s more, the study will require validation with a separate trial, and a closer look at whether the benefits of taking daily statins to address a very low likelihood of suffering a heart attack or a stroke in the face of normal cholesterol levels, outweigh the risk of developing muscle, or liver disease from the statin treatment.

Having said this, regardless of whether the answer for inflammation-induced cardiovascular events is in statin treatment, C reactive protein is probably telling us something very important about how and why heart attacks and strokes develop. This small molecule is a protein that spills out into the blood mostly from the liver, but also from other cells, whenever there is inflammation in the body from infection, autoimmune disease, or cancer. Although it is not known whether the C-reactive protein itself plays a role in inducing heart attacks and strokes, it has been shown over and over to be associated with these events. Personally, I believe that it is not C-reactive protein itself that causes the damage, but several concomitant processes which are at play during inflammation, one of which is a higher propensity to develop atherosclerosis, and to form blood clots.

This is clearly an evolving story, and one that will require more research to yield significant answers about the processes that lead to heart attacks and strokes.

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