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C-Reactive Protein as a Risk Factor for Coronary Heart Disease: A Systematic Review and Meta-analyses for the U.S. Preventive Services Task Force
Annals of Internal Medicine, 10/06/09

Buckley DI et al. – Strong evidence indicates that CRP is associated with CHD events. Moderate, consistent evidence suggests that adding CRP to risk prediction models among initially intermediate–risk persons improves risk stratification. However, sufficient evidence that reducing CRP levels prevents CHD events is lacking.

Methods

MEDLINE search of English–language articles (1966 to November 2007), supplemented by reference lists of reviews, pertinent studies, editorials, and Web sites and by expert suggestions.
Study Selection: Prospective cohort, case–cohort, and nested case–control studies relevant to the independent predictive ability of CRP when used in intermediate–risk persons.
Included studies were reviewed according to predefined criteria, and the quality of each study was rated.
The combined magnitude of effect was determined by meta–analysis.

Results

For good studies that adjusted for all Framingham risk variables, the summary estimate of relative risk for incident CHD was 1.58 (95% CI, 1.37 to 1.83) for CRP levels greater than 3.0 mg/L compared with levels less than 1.0 mg/L.
Analyses from 4 large cohorts were consistent in finding evidence that including CRP improves risk stratification among initially intermediate–risk persons.
C–reactive protein has desirable test characteristics, and good data exist on the prevalence of elevated CRP levels in intermediate–risk persons. Limited evidence links changes in CRP level to primary prevention of CHD events.