Why You Should Ask Your Doctor About HS-CRP

If you have high cholesterol but no other cardiac disease risks, ask your doctor about the High Sensitivity C-Reactive Protein (HS-CRP) test.

The HS-CRP test is an important predictor of heart disease risk. Actually, as explained in Why You Should Ask For Advanced Lipid Testing, if you are concerned about heart disease risk, you might want to ask your doctor about three key tests: HS-CRP, ApoB and LDL Pattern Type. (While they’re separate tests, all are included in one single Advanced Lipid Panel blood test.)

The HS-CRP test in particular predicts heart disease risk by measuring inflammation in the blood vessels. That the HS-CRP blood test is an excellent predictor of heart disease risk has been widely established. A page on the National Institute of Health about HS-CRP states, “Evidence supporting the hypothesis that elevated CRP levels contributes to increased cardiovascular risk is now available from at least six major prospective studies…”

The HS-CRP is particularly relevant for women. WebMD’s Heart Disease and C-Reactive Protein (CRP) Testing article explains that in the large Harvard Women’s Health study (WHS), “results of the CRP test were more accurate than cholesterol levels in predicting heart problems. Twelve different markers of inflammation were studied in healthy, postmenopausal women. After three years, CRP was the strongest predictor of risk. Women in the group with the highest CRP levels were more than four times as likely to have died from coronary disease, or to have suffered a nonfatal heart attack or stroke compared to those with the lowest levels. This group was also more likely to have required a cardiac procedure such as angioplasty (a procedure that opens clogged arteries with the use of a flexible tube) or bypass surgery than women in the group with the lowest levels.”

That said, if you are already taking a statin or being treated for high blood pressure, the HS-CRP test might not be appropriate. According to Dr. Andrew Weil’s What is elevated C-reactive protein? article, “CRP levels don’t appear to help predict the risk of heart disease in patients already being treated for risks such as high blood pressure or high LDL (“bad”) cholesterol. A 2010 analysis of British data on 4,853 patients found that C-reactive protein levels didn’t yield any more information about the risk of heart disease than LDL (“bad”) cholesterol levels or high blood pressure in patients who already were being treated with a cholesterol-lowering statin drug or with medication to lower blood pressure.”  However, it goes on to say that, “Other physicians, including Dr. Weil, think that all adults should have an hs-CRP test whenever their cholesterol is tested.”

A powerful statement.

My cardiologist appears to agree; at my visit on Christmas Eve, he ordered an advanced lipid panel and an HS-CRP test. There was a mixup on the advanced lipid panel prescription (more on that in another post) so I don’t yet have those results, but I was delighted to see that my HS-CRP test came back with even lower risk than last year.

I was surprised at this result, but apparently should not have been. With a bit of research I found that HS-CRP should be measured over time, as there is high variability in this test. According to the Mayo Clinic, “C-reactive protein (CRP) is an acute-phase reactant and has high intraindividual variability. Therefore, a single test for high-sensitivity CRP (hs-CRP) may not reflect an individual patient’s basal hs-CRP level. Repeat measurement may be required to firmly establish an individual’s basal hs-CRP concentration. The lowest of the measurements should be used as the predictive value.”  I saw this in my own results: in December 2014 my HS-CRP level was 0.8 and in December 2015 it was 0.3.

As both of my HS-CRP measurements are below 1.0 mg/L, that puts me at “lower relative cardiovascular risk” according to the goals printed at the bottom of my test results.  Here are the guidelines:

HS-CRP Guidelines

Do you know your heart disease risk as measured by HS-CRP? If you fall into the category of those for whom the HS-CRP test is a good predictor of heart disease risk (meaning, you aren’t already being treated for heart disease or you have an inflammatory disease), ask your doctor about this simple blood test and get more insight into your heart disease risk.

 

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FDA: Trans Fats Are Not GRAS

On Thursday, November 7, the FDA proposed a new law which would effectively eliminate partially hydrogenated oils (PHOs) or artificial trans fats.

Why does this matter?

Because PHOs are in a LOT of the processed food we Americans eat. According to the FDA, PHOs are “the major dietary source of trans fat in processed food.” In fact, PHOs are a key ingredient in many popular snack foods. The NYT article, FDA Ruling Would All But Eliminate Trans Fats, explains that artificial trans fats “still lurk in many popular products, like frostings, microwave popcorn, packaged pies, frozen pizzas, margarines and coffee creamers.”

And I’m betting you (and I) eat plenty of these items — even as we try to watch our cholesterol.

I mean, all of us trying to lower heart disease risk by keeping our cholesterol in check know to avoid red meat and processed food in general. But frozen pizzas? And the occasional bag of microwave popcorn? These seemed to me (until I read about PHOs this week) fairly innocuous.

Apparently not so much.

Which is why the FDA acted. And it was a BIG play they made — the FDA has declared PHOs as “Not GRAS.”  Or, in regular-person-speak, if the FDA proposal passes, partially hydrogentated oils would now be known to be NOT ‘Generally Recognized As Safe.’

This is a radical shift.  HUGE.  The FDA is now saying that this common food additive IS NOT SAFE.

If, after the 60 day comment period, this proposal passes, food companies will not be able to use trans fats – AT ALL.

Which, frankly, is amazing.

It’s been a long time coming.  According to the FDA Targets Trans Fat in Processed Foods article on the FDA website, the FDA proposed all the way back in 1999 that food manufacturers had to specify the amount of trans fat per serving on Nutrition Labels. And it took until 2006 for trans fats to appear by law on nutrition labels.

So it took 7 years to require food labels show trans fats. And 7 years later the FDA wants to ban the use of trans fats.

Why?

According to the FDA site, it will save thousands of lives:

“… there are still many processed foods made with partially hydrogenated oils (PHOs), the major dietary source of trans fat in processed food. Trans fat has been linked to an increased risk of coronary heart disease, in which plaque builds up inside the arteries and may cause a heart attack.

The Centers for Disease Control and Prevention estimates that a further reduction of trans fat in the food supply can prevent an additional 7,000 deaths from heart disease each year and up to 20,000 heart attacks each year.”

Let’s hope it doesn’t take 7 more years for the FDA proposal to take hold and for PHOs to be declared unsafe.

We’ll see what happens after the 60 day period for public comments.

 

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