C-Reactive Protein and Cardiovascular Disease Risk Assessment

C-reactive protein (CRP) is an acute-phase reactant synthesised by the liver in response to systemic inflammation. In cardiovascular disease (CVD), low-grade elevations of CRP, measured with high-sensitivity assays (hsCRP), reflect chronic vascular inflammation and have been linked to the initiation, progression and destabilisation of atherosclerotic plaques. Traditional risk scores for coronary events incorporate age, blood pressure, lipids and smoking history, but they may underestimate risk in individuals with subclinical inflammation. Incorporation of hsCRP into risk-stratification algorithms has been shown to modestly improve prediction of myocardial infarction and stroke, particularly in intermediate-risk groups. In parallel, imaging studies reveal that elevated hsCRP correlates with features of vulnerable plaque, such as lipid-rich cores and thin fibrous caps. Clinically, measurement of hsCRP can guide preventive strategies, including intensity of statin therapy and consideration of anti-inflammatory agents, and supports a move towards personalised cardiovascular care with both lipid-lowering and inflammation-targeted interventions.

Research from Nature Portfolio

A large population-based cohort of middle-aged adults underwent coronary computed tomography angiography alongside hsCRP measurement to explore the value of systemic inflammation in detecting coronary atherosclerosis. Elevated hsCRP was weakly associated with the presence and extent of coronary plaque after adjustment for age, sex and traditional risk factors. Associations diminished further on adjustment for body mass index, yet hsCRP remained linked to noncalcified, potentially vulnerable plaques. These findings underscore the limited incremental value of hsCRP for general screening but highlight its association with high-risk lesion characteristics that may underpin the relationship between inflammation and clinical events.

C-Reactive Protein and Cardiovascular Disease Risk Assessment publication trend

The graph below shows the total number of articles in c-reactive protein and cardiovascular disease risk assessment across all publications each year (not limited to Nature Index journals).

Technical terms

C-reactive protein (CRP): An acute-phase protein produced by the liver, rising in response to inflammation and tissue injury.

High-sensitivity C-reactive protein (hsCRP): A refined assay capable of detecting low-grade elevations of CRP, useful in cardiovascular risk prediction.

Atherosclerosis: A chronic arterial disease characterised by lipid deposition, inflammation and plaque formation in vessel walls.

Risk stratification: The process of categorising individuals by their likelihood of future cardiovascular events to guide preventive measures.

Noncalcified plaque: A type of atherosclerotic lesion with a lipid-rich core and thin fibrous cap, considered more prone to rupture and thrombosis.

References

1. Atherosclerosis and Its Related Laboratory Biomarkers. International Journal of Molecular Sciences (2023).
2. Association between high-sensitivity C-reactive protein and coronary atherosclerosis in a general middle-aged population. Scientific Reports (2023).
3. C-Reactive Protein: The Quintessential Marker of Systemic Inflammation in Coronary Artery Disease—Advancing toward Precision Medicine. Biomedicines (2023).