Impact of C-reactive protein on treatment of patients with cardiovascular disease.

Purpose: The impact of C-reactive protein (CRP) on the treatment of patients with cardiovascular disease is described.

Summary: CRP is a marker of coronary heart disease and other disease states. Its release from the liver activates endothelial dysfunction and contributes to atherothrombosis. In healthy persons, CRP was found to be an independent risk marker for cardiovascular disease when compared with low-density-lipoprotein (LDL) cholesterol. In 2003, the Centers for Disease Control and Prevention and the American Heart Association published a statement regarding CRP's use in clinical practice and public health. In a primary prevention study, statins were shown to reduce CRP, and patients with a low concentration of LDL cholesterol and high CRP may benefit from statin therapy. The results of a secondary prevention study confirmed that CRP reduction was not related to the lipid-lowering effects of the statins and that pravastatin reduced coronary events regardless of inflammation status designated by the CRP value. Another study demonstrated that intensive pharmacotherapy was more effective than moderate therapy in reducing CRP, but it found no difference in clinical outcomes among statin regimens once the goal CRP value was attained. In atheroma ultrasound studies, a reduced CRP level was related to reductions in atheroma volume regardless of the statin regimen used.

Conclusion: The correct use of CRP in pharmacotherapeutic monitoring of statins has not been fully elucidated. Until more data regarding CRP and statin use are available, pharmacists must continue to focus on risk factors other than CRP, such as cholesterol levels, medical history, social history, and lifestyle characteristics, when making clinical decisions regarding statin therapy.