More on CRP

The two NEJM articles on C-Reactive Protein which I commented on yesterday have raised quite a stir.

Gina Kolata’s headline in the NY Times that I saw in my print paper yesterday blared: “Two Studies Suggest a Protein Has a Big Role in Heart Disease“. Today, I went to the Times website to find the exact wording of that headline, and did a quick search for CRP. The search yielded two results pointing to that same article: one had the headline that was worded as above, and a second with a different headline: “Protein Is Factor in Heart Disease, Researchers Say”. Hmm. And today, Kolata has a more subdued article entitled: “A Quandary in Good News“.

The two studies really show only one thing: If you have coronary disease and if you are treated with a statin, then you do better if your CRP is lower (or drops more) than if it doesn’t. That’s it. They do raise a bunch of unanswered questions, however:

  • Is CRP an active participant or just a marker? If it is an active participant, then lowering CRP levels should, indeed, be a direct priority and researchers should be looking at ways to do this. If it is just a marker, then what, exactly, is it a marker for? Is there some other factor that we should be targetting, rather than the CRP?
  • Granted that statin therapy can lower CRP, is it possible to lower it more with more intensive therapy? How much lower? Using what drugs or drug combinations?
  • And even if patients whose CRP’s drop more with statin therapy do better than those whose CRP’s drop less, does this mean that using drug manipulation to push the levels of the “poor responders” down further will guarantee the same outcome?
  • What about non-vascular causes of inflammation? What do those elevated CRP levels mean for cardiovascular prognosis? And are there any non-vascular conditions that lower CRP levels (like CHF can lower sedimentation rates)?
  • If we want to use the CRP to guide our choice of and aggressiveness with therapy, how often should we be measuring it? Find out from your local laboratory what they charge for a lipid panel and what they charge for a CRP. Presumably prices will drop, but it will still be one added expense that will be multiplied millions of times.

Lots of stuff still to be learned. And lots of phone calls from patients to be fielded.

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