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.