High Attributable Risk of Elevated C-Reactive Protein Level to Conventional Coronary Heart Disease Risk Factors

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Abstract
Inflammation has been implicated in the origination and progression of cardiovascular disease,1 and among the most actively studied biomarkers is C-reactive protein (CRP), an acute-phase reactant released predominantly by hepatocytes.2 While low-grade inflammation is predictive of coronary heart disease (CHD),3 even in the absence of elevated low-density lipoprotein cholesterol levels,4 the extent to which high CRP level is attributable to well-established CHD risk factors has not been well studied. This is an important issue to investigate in view of the numerous proponents for or against CRP level as a CHD screening tool5-8 and a recent Centers for Disease Control and Prevention and the American Heart Association scientific statement9 reserving CRP measurements for those patients at intermediate CHD risk (defined as a 10-year CHD risk range of 10%-20%). If elevated CRP level is intimately linked to conventional CHD risk factors, then routine screening of this biomarker would seemingly be less valuable to clinicians. Therefore, the present study was undertaken to evaluate the extent to which high CRP levels (>3 mg/L) may simply reflect expression of the pathobiologic changes induced by conventional CHD risk factors.

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