Has your doctor measured your C-reactive protein (CRP) level, and found it to be elevated? This is an increasingly common situation, despite the fact that most experts, including the United States Preventive Services Task Force, do not recommend routinely measuring CRP levels. (Read here about when CRP actually should be measured.)
CRP is a nonspecific biomarker of inflammation. That is, when CRP levels are elevated, that is an indication that inflammation is occurring somewhere in the body. So, for instance, if you have an infection or active bursitis, your CRP level is likely to be high.
However, it turns out that when CRP levels remain chronically elevated in apparently healthy people with no signs of active inflammation, that can be an indication that chronic inflammation of he blood vessels is present. This type of low-grade vascular inflammation contributes to atherosclerosis and cardiovascular disease.
Ok, It’s Elevated. Now What?
It is likely that you may be puzzled, or even alarmed, by finding that your CRP is high. Unfortunately, it is reasonably likely that your doctor is also puzzled about what to do next — since “what to do next” is not entirely straightforward.
While it is now well established that inflammation is an important contributor to atherosclerosis, and that elevated CRP (which is a marker for inflammation) is associated with an increased risk of coronary artery disease (CAD), it is not known whether CRP itself actually contributes to CAD. Likewise, it is not known whether treatment aimed specifically at lowering CRP levels can reduce cardiovascular risk.
When your CRP is high your risk of developing CAD is also higher than it ought to be. But we don’t really know how much it helps to take steps aimed specifically at reducing your CRP levels. What we do know is that when your cardiovascular risk is elevated, you need to take every opportunity you have to reduce that risk.
What Should Happen Next
Now that you know your CRP is high, there are two questions you should be asking.
1) What are my other risk factors?
Elevated CRP levels are almost always associated with other risk factors for heart disease.
These include smoking, obesity, sedentary lifestyle, increased cholesterol, hypertension, and diabetes or metabolic syndrome. All of these risk factors are extremely important, and you and your doctor have the ability to get all of them under control.
So, whatever you and your doctor may decide to do about the CRP itself, having an elevated CRP makes it even more important to take aggressive measures to reduce all your cardiac risk factors.
2) How can I reduce my CRP level?
While it is still uncertain how important it is to reduce an elevated CRP level itself, several ways of reducing CRP have been identified:
Non-pharmacological methods of reducing CRP include aerobic exercise, smoking cessation, weight loss and a heart-healthy diet. In other words, taking aggressive steps to make your lifestyle healthier will also result in a reduced CRP level.
Drug therapy can also reduce CRP. **Statins ** reduce CRP levels significantly (13 to 50%,) according to several clinical trials. Lipitor (atorvastatin), Mevacor (lovastatin), Pravachol (pravastatin), Crestor (rosuvastatin) and Zocor (simvastatin) have all been demonstrated to bring down CRP levels and have shown evidence of reducing cardiac risk through CRP (as opposed to cholesterol) reduction. Also, the JUPITER trial showed definitively that in patients with high CRP levels but “normal” cholesterol levels, Crestor significantly and substantially reduced cardiovascular risk.
While aspirin does not reduce CRP levels, people with elevated CRP levels gain more risk-reduction benefit from aspirin than those with normal CRP levels. So elevated CRP levels may tip the scales in favor of prophylactic aspirin therapy for some.
Read more about who should take prophylactic aspirin.
A Word From Tips For Healthy Living
It remains unknown whether CRP itself increases cardiovascular risk, or whether it merely reflects the vascular injury and inflammation that results from other risk factors. So if your CRP levels are elevated, you should take that as an important sign that it is time to get serious about reducing allyour cardiac risk factors by exercising, not smoking, losing weight, watching your diet, and controlling your blood pressure.
However, it now appears clear that the use of statin drugs can substantially reduce the risk of heart attack and stroke in even healthy-appearing patients whose CRP levels are high.
If you have high CRP levels, especially if you have one or more additional risk factors for heart disease, you should discuss the option of taking a statin drug with your doctor.