C-reactive Protein High Sensitivity

When To Test Crp

After trauma occurs in the body, inflammation usually begins around 6 to 12 hours after and peaks around 48 to 96 hours after the event.

Once diagnosed with a major issue, you should test your CRP levels every once and a while to determine if your treatment is working or if modifications are necessary. C-reactive protein levels will correlate with the severity of the disease, so if the levels are rising, so should your concern.

The Application Of High

Michelle L. Knight, PharmDPGY-2 Pharmacy ResidentDepartment of Pharmacotherapy & Translational ResearchCollege of PharmacyGainesville, Florida

US Pharm

ABSTRACT: The role of inflammatory markers in cardiovascular disease progression and risk assessment has been a topic of discussion for nearly two decades. This subject was most recently addressed by guidelines from the American College of Cardiology and the American Heart Association, as well as the National Lipid Association. Evidence supports the association of high-sensitivity C-reactive protein with cardiovascular disease. Hs-CRP testing may improve risk stratification, particularly among intermediate cardiovascular risk patients, although further research is warranted.

What Are Crp Tests Normal Ranges

Optimal CRP levels for everyone to strive for is under .55 mg/L in men and under 1.0 mg/L in women.

It is common for heavier individuals to have higher CRP levels since fat around the abdomen provides space for over-production of deadly pro-inflammatory cytokines that cause CRP to increase.

The fact that CRP test levels are high doesnt mean its a bad thing if recent trauma has occurred in the body, the problems begin when the levels dont go back down to normal after a while. This can indicate a destructive chronic inflammation that should be looked into by a medical professional.

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What Crp Level Is Dangerously High

Whether a CRP level is dangerous will depend on the type of c-reactive protein test used, your individual medical history, and the suspected cause of inflammation. Your healthcare provider can best explain the test results to you. In general, anything above 1 mg/dL is elevated and may require intervention. The higher the level, the more likely you will need a diagnosis and treatment for its cause.

Why It Is Done

This test may be done to find out if you have an increased chance of having a sudden heart problem, such as a heart attack. But the connection between high CRP levels and heart attack risk is not understood very well.

A high level of CRP may mean a higher-than-normal risk of heart problems. If your risk for heart problems is high, your doctor may recommend lifestyles changes or medicine to help lower your risk.

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What Does The Test Result Mean

Relatively high levels of hs-CRP in otherwise healthy individuals have been found to be predictive of an increased risk of a future heart attack, stroke, sudden cardiac death, and/or peripheral arterial disease, even when cholesterol levels are within an acceptable range.

People with higher hs-CRP values have the highest risk of cardiovascular disease and those with lower values have less risk. Specifically, individuals who have hs-CRP results at the high end of the normal range have 1.5 to 4 times the risk of having a heart attack as those with hs-CRP values at the low end of the normal range.

The American Heart Association and U.S. Centers for Disease Control and Prevention have defined risk groups as follows:

• Low risk: less than 1.0 mg/L
• Average risk: 1.0 to 3.0 mg/L
• High risk: above 3.0 mg/L

These values are only a part of the total evaluation process for cardiovascular diseases. Additional risk factors to be considered are elevated levels of cholesterol, LDL-C, triglycerides, and glucose. In addition, smoking, high blood pressure , and diabetes also increase the risk level.

Whats The Link Between Crp And Cardiovascular Health

When inflammation becomes chronic, it leads to changes in your blood vessels making them more permeable to fat and cholesterol and leading to the formation of plaque on the blood vessel walls. This is why chronic inflammation can cause atherosclerosis and heart attacks¹ and elevated levels of CRP are associated with an increased risk for cardiovascular disease.

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Why Do Healthcare Providers Perform Crp Tests

Healthcare providers typically order a C-reactive protein test to help diagnose or rule out certain conditions, including:

• Severe bacterial infections, such as .
• Fungal infections.

• Nausea and vomiting.

Your provider may also use CRP tests to monitor your treatment if youve already been diagnosed with an infection or a chronic inflammatory condition.

CRP levels increase and decrease depending on how much inflammation your body has. If your CRP levels go down, it’s a sign that your treatment for the inflammation is working.

What Is The Most Likely Cause

Chronically elevated CRP levels often signal RA or infectious arthritis, which occurs when a joint becomes infected.

Significantly elevated CRP levels tend to occur with severe infections, such as bacterial or fungal infections. Bacterial infection is responsible for about of the cases involving CRP levels higher than 50 mg/l.

Sometimes, higher levels also occur with certain cancers and other conditions that can cause significant inflammation.

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Addressing Your Risk Factors

A number of risk factors may contribute to CRP levels, and there may be benefits to taking steps to reduce your CRP levels. Treatment aimed at lowering CRP levels may reduce cardiovascular risk, but researchers are still working to understand these relationships.

Elevated CRP levels are almost always associated with other risk factors for heart disease, including:

• Metabolic syndrome

Talk to your healthcare provider about your heart disease risk factors and what can be done to address them and your CRP levels.

This may involve habit changes, weight loss efforts, and/or medication.

Elevated CRP is associated with increased risk of heart disease. While it’s uncertain how much reducing CRP itself can help, elevated levels are a sign that you likely have other risk factors that need to be addressed with aggressive measures.

Risk Of Cardiovascular Events Across Lp Strata According To Hscrp Thresholds

shows the results of Cox proportional hazard model exploring the risk of CVD events across Lp strata . Again, in the setting of hsCRP < 2 mg/L, no significant association between Lp and CVD risk was observed in any of the Lp categories. However, in the setting of elevated hsCRP , a significant risk of CVD events was observed with increased levels of Lp 50-99.9 mg/dL and Lp 100 mg/dL .

Figure 1

Cardiovascular Risk Across Clinical Strata of Lp

HRs for cardiovascular events. Cox proportional hazards model was adjusted for age, sex, race/ethnicity, hypertension, use of hypertension medications, diabetes, smoking status, high-density lipoprotein cholesterol, triglycerides, total cholesterol, and renal function . Point estimates of HRs are represented by the blue dots and 95% CI by the horizontal lines. Kaplan-Meier curves of cumulative incidence of cardiovascular events. Lp < 50 mg/L was used as the reference group. CVD = cardiovascular disease hsCRP = high-sensitivity C-reactive protein Lp = lipoprotein.

displays the cumulative incidence of CVD events over a mean follow-up of 13.6 years across Lp strata according to hsCRP thresholds. In those with hsCRP < 2 mg/L, increasing Lp was not associated with a higher cumulative incidence of CVD . However, in those with hsCRP 2 mg/L, cumulative incidence of CVD was significantly higher in the Lp 50-99.9 mg/dL group, and highest in those with Lp 100 mg/dL . Similar results were found while Lp was assessed by quartiles .

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Why Do I Need A Crp Test

You may need this test if you have symptoms of a serious bacterial infection. Symptoms include:

• Nausea and vomiting

If you’ve already been diagnosed with an infection or have a chronic disease, this test may be used to monitor your treatment. CRP levels rise and fall depending on how much inflammation you have. If your CRP levels go down, it’s a sign that your treatment for inflammation is working.

Funding Support And Author Disclosures

MESA is supported by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the National Heart, Lung, and Blood Institute and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from National Center for Advancing Translational Sciences. The MESA Air ancillary study was supported by a grant from the US Environmental Protection Agencys Science to Achieve Results program. Assistance Agreement number RD831697 awarded by the U.S. Environmental Protection to the University of Washington. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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Assessment Of Exposure Outcome And Covariates

The CRP concentration was measured by immunoturbidimetric-high sensitivity analysis on Beckman Coulter AU5800 at baseline, with a range from 0.08 to 79.96 mg/L. The outliers were capped by the 1st percentile or 99th percentile of CRP level. A special detail of collection and processing of blood sample has been described elsewhere .

Cancer outcomes were defined based on the ICD10 coding and obtained from the national cancer registry. The follow-up time referred to the period from baseline enrollment to the first diagnosis of cancer, the first registration of cancer or loss, or end of follow-up . After excluding site-specific cancer with less than 100 incident cases, we finally included overall cancer and 21 site-specific cancers in this study .

How Is The Test Used

A high-sensitivity C-reactive protein test measures low levels of CRP and may be used to help evaluate an individual for risk of cardiovascular disease . It may be used in combination with a lipid panel or with other cardiac risk markers, such as a lipoprotein-associated phospholipase A2 test, to provide added information about heart disease risk.

High-sensitivity CRP is thought by some experts to be a useful test for determining risk of CVD, heart attacks, and strokes and that hs-CRP can play a role in the evaluation process before a person develops one of these health problems. Some say that the best way to predict risk is to combine a good marker for inflammation, like hs-CRP, with the lipid panel. Several groups have recommended that this test be used for people who have a moderate risk of heart attack over the next 10 years.

However, not all health professionals agree on hs-CRPs usefulness. Clinical trials that involve measuring hs-CRP levels are currently underway in an effort to better understand its role in cardiovascular events. These studies will help to form and refine guidelines on its use in screening and treatment decisions.

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When Is It Ordered

Currently, there is no consensus on when to get tested, though some guidelines include recommendations on hs-CRP testing. For example, a guideline from the American College of Cardiology Foundations and the American Heart Association says that hs-CRP testing may be useful when men 50 years old or younger and women 60 years old or younger have intermediate risk. It also may be useful for treatment decisions when men and women are older than these respective ages and have LDL-C less than 130 mg/L and meet several other criteria, such as no existing heart disease, diabetes, kidney disease, or inflammatory conditions.

When hs-CRP is evaluated, it may be repeated to confirm that a person has persistent low levels of inflammation. The CDC and the American Heart Association recommend that measurement of hs-CRP greater than 10 mg/L be repeated twice, optimally two weeks apart, fasting or non-fasting in patients free of infection or acute illness.

Cholesterol Testing May Not Be Enough

Coronary Heart Disease is the number one cause of death in America. Stroke is number three. Cholesterol testing has been used to help identify those people who may have an increased risk of developing heart disease. 35% of CHD occurs in people whose cholesterol level is below 200 . Now there is a new test called High Sensitivity CRP that is useful in predicting future coronary events in these individuals.

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When To Treat High Crp Levels

As an additional cardiovascular risk factor, CRP levels identify those people who are more at risk for cardiovascular disease. But how useful is that information to the physician and patient?

Cholesterol-lowering medication such as a statin have been shown to lower CRP levels. A CRP test taken out of context can have questionable value. For example, if youre at low cardiovascular risk and your CRP level is borderline high, the long-term benefit of taking a statin to keep your CRP low is up for debate and further study.

Inclusion And Exclusion Criteria

Patients diagnosed with T2DM at age 18 and above were included, having a regular monitoring check-up including clinical laboratory data in 2019. The study excluded persons with a chronic disease medical history and long-term treatment other than forT2DM, as well as patients with renal, cardiovascular, or neurological abnormality. In addition, children, pregnant women, and patients with type 1 diabetes were excluded.

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Crp And Cardiovascular Disease

Although circulating levels of several inflammatory mediators correlate with increased coronary risk, CRP has attracted particular attention.4,5 Plasma CRP has a long half-life in the circulation , high stability, and negligible circadian variability, and can be measured inexpensively using standardized high-sensitivity assays.6,7

CRP provides a functionally integrated assessment of overall upstream cytokine activation. It also exhibits activities that may directly affect vascular disease, such as activation of the complement system.7

CRP is primarily secreted by the liver. However, it may also be produced by vascular sources, including cells residing in atherosclerotic plaques.

Limitations Of The Study

One limitation is that the study was conducted in a single geographic region therefore, a long-term conclusion cannot be made and results may not apply to other geographic regions. Second, this study was a cross-sectional design, limiting ability to draw a cause- and-effect conclusion. Third, we did not measure serum insulin levels.

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What Does It Mean If Your C

If you get abnormal C-reactive protein test results, meaning that your level is above the cutoff for whats considered to be normal, then there are a few different possibilities for what this might indicate.

With C-reactive protein, high levels indicate that theres inflammation in your body. One use of CRP is to determine whether a patients symptoms are caused by an inflammatory or infectious disease. For example, CRP is commonly measured in arthritis testing. When trying to determine the cause of your joint inflammation, a doctor may order this test. If your C-reactive protein is high, meaning that theres a higher level of inflammation in your body, this points to an autoimmune diagnosis like rheumatoid arthritis or lupus, rather than a wear-and-tear condition or injury.

If youve had the CRP or hs-CRP test because you may be at risk of heart attacks, your doctor will use your specific value to help determine your risk of having a heart attack in the next 10 years. If you have high C-reactive protein test results, meaning that your level is above whats considered to be normal, this is only one factor thats used in determining your risk of a future heart attack. By itself, a high CRP level doesnt always mean that youre at a high risk.

Is There Anything Else I Should Know

Taking nonsteroidal anti-inflammatory drugs or statins may reduce CRP levels in blood. Both anti-inflammatory drugs and statins may help to reduce inflammation, thus reducing CRP.

Women on hormone replacement therapy have been shown to have elevated hs-CRP levels.

Since the hs-CRP and CRP tests measure the same protein, people with chronic inflammation, such as those with arthritis, should not have hs-CRP levels measured. Their CRP levels will already be very high due to the arthritis, so results of the hs-CRP test will not be meaningful.

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What Is The C

When youre looking at your blood results, CRP or hs-CRP should be specified. The results will be interpreted slightly differently, depending on the type of test and the reason for the test.

For the standard C-reactive protein test, levels should be at 10 mg/L or below. Theres no such thing as a CRP level thats too low.

For the high sensitivity C-reactive protein test, levels higher than 2 mg/L are considered to put you at higher risk for heart disease, while lower levels are associated with a lower risk.

Is There Any Certain Age That I Should Have My Crp Tested

All current studies have been performed on middle-aged men and women, as well as the elderly. No data is available for the benefits of testing in children or young adults.

References:

• Clinical Chemistry 2001, 47:3:403-411
• Ridker, P, et al. 1997. Inflammation, Aspirin and the Risk of Cardiovascular Disease in Apparently Healthy Men.
• New England Journal of Medicine 1997 336:973-979.
• American Heart Association Journal Report 11/05/1999 Blood Marker Can Signal Trouble for Individuals with Heart Disease.

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What To Expect During The Test

A nurse or other healthcare professional will draw blood from a vein, usually on the inside of your elbow or the back of your hand.

First, they clean the skin over the vein with antiseptic. Next, they wrap an elastic band around your arm, causing your veins to bulge out slightly. The healthcare professional then inserts a small needle into the vein and collects your blood in a sterile vial.

After the healthcare professional collects your blood sample, they remove the elastic band around your arm and ask you to apply pressure to the puncture site with gauze. They may use tape or a bandage to hold the gauze in place.

What Elevated Crp Levels Mean

When CRP levels remain elevated for a long time, it can indicate chronic inflammation of the blood vessels. This type of low-grade inflammation contributes to the deposit of fat and other substances in the artery walls, a condition called atherosclerosis.

This build-up can narrow the arteries that feed the heart blood, causing coronary artery disease . Over time, heart attack, stroke, or heart failure can occur. This is true even for those with elevated CRP levels who have no obvious symptoms or signs of active inflammation.

Inflammation is an important contributor to atherosclerosis and elevated CRP is associated with an increased risk of CAD. A study of 376 people found that 210 of them diagnosed with CAD all had elevated CRP levels when compared with 166 people who did not have CAD.

The CRP level increased in step with the degree of blood vessel damage evaluated by coronary angiography, an imaging test used to visualize blood flow through the heart.

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