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C-Reactive Protein Risk Prediction: Low Specificity, High Sensitivity

Wolfgang Koenig, MD; and Mark B. Pepys, MD, PhD
[+] Article, Author, and Disclosure Information

From the University of Ulm Medical Center, Ulm, Germany; and the Royal Free and University College Medical School, London, United Kingdom

Disclosures: Dr. Koenig has received fees for speaking about CRP from Dade–Behring and Instrumentation Laboratory and has been reimbursed for lectures on inflammation and cardiovascular disease by Bristol–Myers Squibb, Merck Sharp and Dohme, and Sankyo. Dr. Pepys has received fees for speaking and consulting about CRP from Abbott Laboratories, Dade–Behring, and Roche Diagnostics.

Requests for Single Reprints: Wolfgang Koenig, MD, Department of Internal Medicine II—Cardiology, University of Ulm Medical Center, Robert-Koch Strasse 8, D–89081 Ulm, Germany; e-mail, wolfgang.koenig@medizin.uni-ulm.de.

Current Author Addresses: Dr. Koenig: Department of Internal Medicine II—Cardiology, University of Ulm Medical Center, Robert-Koch Strasse 8, D–89081 Ulm, Germany.

Dr. Pepys: Centre for Amyloidosis and Acute Phase Proteins, Department of Medicine, Royal Free and University College Medical School, Rowland Hill Street, London NW3 2PF, United Kingdom.

Ann Intern Med. 2002;136(7):550-552. doi:10.7326/0003-4819-136-7-200204020-00014
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Convincing evidence indicates that both local inflammation in the arterial wall and systemic signs of inflammation are important in atherogenesis and in complications of atherosclerotic disease. Consistent results from more than 15 well-conducted prospective studies in initially healthy persons (1) have shown a strong and independent association between the circulating concentration of C-reactive protein (CRP)—the classic acute-phase reactant, measured by high-sensitivity assays—and cardiovascular end points, including acute myocardial infarction, stroke, and progression of peripheral arterial occlusive disease. This strong association is seen for both primary and secondary prevention (patients with manifest atherosclerotic disease). Increased CRP levels predict recurrent instability in patients admitted with an acute coronary syndrome; in patients undergoing invasive procedures, such as percutaneous transluminal coronary angioplasty, stenting, or bypass grafting; and in other high-risk groups, such as patients with renal insufficiency and those who have had transplantation. Thus, CRP is itself an important general marker of increased risk for cardiovascular events, including death, and has also been shown to add to risk prediction based on conventional risk factors (2). The latter observation is of considerable importance because about half of all new cardiovascular events occur in persons without classic risk factors.

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