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Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• What is C-reactive protein (CRP)?
• What are the main causes of an elevated C-reactive protein (CRP)?
• Is there a link between C-reactive protein (CRP) and cardiovascular disease risk?
• Is elevated C-reactive protein (CRP) a risk factor for cardiovascular disease?
• How is C-reactive protein (CRP) measured?
• How can C-reactive protein (CRP) values predict potential heart disease?
• Should I have my C-reactive protein (CRP) level tested?
• What is the treatment for high C-reactive (CRP) protein?
• What is the outlook on elevated C-reactive (CRP) protein?
• Patient Comments: C-Reactive Protein Test (CRP) - Testing
• C-Reactive Protein Test (CRP) Index

How can C-reactive protein (CRP) values predict potential heart disease?

According to the American Heart Association (AHA) and the Center for Disease Control (CDC), the following guidelines are recommended for the assessment of cardiovascular risk in regards to CRP levels:

• Low risk for cardiovascular disease if CRP is 1 milligram (mg) per liter or less
  
  
• Moderate risk for cardiovascular disease if CRP is between 1 and 3 mg per liter
  
  
• High risk for cardiovascular disease if CRP greater than 3 mg per liter

CRP level of greater than 10 mg per liter may be seen in an acute plaque rupture such as, a heart attack or stroke, provided there is no other explanation for the elevated level (other inflammatory or infectious process).

Should I have my C-reactive protein (CRP) level tested?

Checking the CRP level for the entire adult population is not recommended.

Some experts recommend checking the serum CRP level routinely along with the cholesterol level; however, although this is not widely accepted. Ideally, for cardiac risk testing, it is advisable to use the average between 2 separate CRP levels drawn 2 weeks part.

More importantly, the CRP level can provide additional information about an individual's cardiovascular risk in conjunction with other known cardiac risk factors, such as, diabetes mellitus, high blood pressure, high cholesterol, obesity, age, and smoking.

What is the treatment for high C-reactive protein (CRP)?

The treatment of an elevated CRP in the context of cardiovascular disease, in and of itself, may be meaningless. Instead, appropriate treatment and prevention of the underlying risks and conditions need to be the primary focus of cardiovascular risk reduction.

The most effective and reliable ways to reduce many cardiac factors are regular exercise, balanced diet, and cigarette smoking cessation. In individuals with elevated cholesterol levels who do not reach their target cholesterol level with diet modification and proper exercise, cholesterol lowering medication may be advised by their treating physicians. Statin drugs (simvastatin [Zocor], atorvastatin [Lipitor], etc.) are in the forefront of the recommended cholesterol lowering agents. Lowering of CRP may be seen with the use of statin drugs even without significant improvement of the cholesterol profile.

Reduction of CRP level has also been noted in individuals with known cardiovascular disease who begin aspirin therapy. In those without known cardiovascular disease or significant risk factors for it, aspirin use is not generally recommended. Some diabetic medications (thiazolidinediones) have also been shown to reduce CRP levels in people with or without diabetes mellitus. This effect was seen independent of the glucose their lowering effects.