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Armstrong also works in a primary care clinic and said for patients with borderline high cholesterol, a CRP test showing signs of inflammation of coronary arteries can help persuade patients to make some healthy lifestyle changes or take medications that will lower the lipid count. Accepted CRP levels for low risk of developing cardiovascular disease is a reading below 1.0 mg/L; average risk is between 1.0 mg/L and 3.0 mg/L; and high risk is above 3.0 mg/L.
“It’s a very good motivator to have that CRP number,” says Armstrong. “It’s not an absolute indicator of cardiovascular disease, but it does add to the total picture and I’ve used it that way.”
At the Arizona Heart Institute in Tucson, clinical manager Teresa Capriotti, RN, BSN, says CRP testing is done selectively, usually with patients who are asymptomatic but have a family history that qualifies as a risk factor, usually a father with heart disease before age 45 or a mother before age 55.
“We tend to stick with the gold standard – a total lipid panel that measures total cholesterol and a breakdown of HDL (good) cholesterol and LDL (bad) cholesterol,” says Capriotti. Patients with various degrees of risk are put on diet and exercise routines and if needed, given Lipitor or another cholesterol-lowering statin, she says.
Capriotti says the CRP test only shows the level of risk from inflammation, whereas patients with abnormal cholesterol readings will definitely be in danger from coronary cardiovascular disease. A cardiac nurse for more than 20 years, Capriotti says shealso seen obesity become much more prevalent and a major risk factor, challenging nurses who are trying to help patients improve their lifespan.
President Clinton
“We are talking all the time about diet and exercise and that they really must maintain a healthy balance in the foods that they eat,” says Capriotti. She says people do seem to understand the minimum risk factors and that the institute got a 30% increase in calls from concerned people when the seemingly healthy former President Bill Clinton was hospitalized for heart surgery and had a battery of tests, including CRP.
“Men and women who were asymptomatic were coming in for tests,” says Capriotti. “We’re still getting calls.”
The Clinton emergency, which revealed three almost totally clogged arteries after he complained of chest pains, shocked some leading cardiologists who have called for more aggressive use of preventive screening, such as blood marker tests and wider use of a noninvasive and costlier diagnostic test known as the coronary calcium scan. About 2.1 million Americans have heart attacks each year, and 50% of these attacks occur without symptoms or diagnosed high-risk factors, according to the American Heart Association.
Gail Pritchett, RN, a specialist in cardiac rehabilitation at Southwest Medical Center in Vancouver, Wash., says clinics there offer a “risk factor profile” that includes a cholesterol panel, CRP test, and a check of homocysteine levels. Family history and other major risk factors are also looked at on an individual basis.
She says the best evidence-based treatments are used, depending on the patient profile. This includes the use of statins or combinations of medications to reduce high cholesterol and CRP levels and prescription-strength folates that easily treats high homocysteine levels.
“CRP is an important piece of the risk factor panel,” says Pritchett, a team manager for 12 nurses at a cardiac rehab center. “People who don’t have high cholesterol can have elevated CRP that may be the first sign that something’s going on with the life of the arteries.”
A recent study by Duke University researchers has also come up with a new heart attack risk factor — negative emotions. Depression, anger and hostility were found to trigger high levels of CRP, which isn’t surprising to Pritchett.
“Anger and hostility could play a part,” says Pritchett, adding that adrenaline from stress is also known to raise CRP levels. “Everything is interconnected when it comes to keeping the heart healthy.”
John Leighty is a freelance writer.
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