2. Aims and Objectives
Introduction – why look for new biomarkers?
Possible candidates.
hsCRP - Primary CHD.
- Disadvantages.
Clinical relevance.
3. Traditional risk factors
Low specificity and sensitivity:
1. Coronary events occur in those with low risk lipid
levels. (Ridker et al, 2002)
2.20-25% of events occur in those with only one risk
factor. (Khot et al, 2003)
9. Incident myocardial infarction
28, 263 women, used a
commercially available assay
for hsCRP.
(Ridker et al, 2000)
27,939 women, showing CRP
t0 be better than LDL.
(Ridker et al, 2002)
11. Clinical risk stratification tools
50% of
intermediate
risk women
re-classified.
More
accurate
correlation
with
observed
disease.
(Ridker et al, 2007a)
12. Clinical risk stratification tools
50% of
intermediate
risk women
re-classified.
More
accurate
correlation
with
observed
disease.
(Ridker et al, 2007)
13. Response to statin therapy
Effects seen to be largely independent of changes in
lipid concentration.
(Albert et al, 2001)
14. Response to statin therapy
Effects seen to be largely independent of changes in
lipid concentration.
(Albert et al, 2001)
16. Future treatment
The JUPITER trial.
17,802 person with LDL cholesterol <3.36 mmol/Litre,
but hsCRP over >2 mg/Litre from 26 countries.
Randomised to 20mg Rosuvastatin OD or placebo.
Enrolment completed by December 2006, with initial
three year follow up.
(Ridker et al, 2007b)
17. Disadvantages to CRP
Genetics – Is the ability to make CRP genetically
determined?
Inflammation – Can risk stratification be influenced
by systemic inflammation?
18. Implications for practice
America – 2003 CDCP/AHA publish first set of
guidance cautiously endorsing use of CRP as an
adjunct to traditional risk factors.
(Pearson et al, 2003)
UK – 2007 NICE guidance on secondary prevention of
MI gives no mention of CRP.
UK – 2010 NICE “Guidance on the prevention of
cardiovascular disease at the population level,”
expected.
http://www.nice.org.uk
19. Conclusion
The evidence base for CRP as a predictor of first
cardiovascular events is strong.
A response to statin therapy allows CRP to be clinically
useful.
American regulatory bodies have endorsed the use of CRP.
In time, a host of inflammatory mediators may be used to
calculate risk.
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