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Biomarker screening in primary prevention

8 Nov, 12 | by Alistair Lindsay

Risk prediction models are widely used in primary care to identify and initiate therapy in those at risk for future cardiovascular events. While conventional risk factors such as smoking and hypertension are reliably and robustly represented in these models, the value of newer emerging biomarkers such as C-reactive protein (CRP) and fibrinogen are of uncertain value. In this very large meta-analysis of data from 52 prospective studies, including 246,669 participants being evaluated for primary prevention, the value of adding CRP or fibrinogen levels to conventional risk factors was studied with the clinical implications being modelled on the initiation of statin therapy after reclassification of individuals on biomarker levels. more…

Statins show benefit regardless of CRP

6 Feb, 11 | by Alistair Lindsay

Some previous studies – most noticeably the JUPITER trial – have suggested that the vascular benefits of statin therapy may be greater in the presence of inflammation.  C-reactive protein (CRP), a systemic marker of inflammation, has been associated with the risk of ischaemic heart disease, stroke, and vascular mortality, but its ability to act as a biomarker that can be used to guide treatment remains controversial.  This study tested the hypothesis that the effects of statin therapy differ according to baseline concentrations of CRP and LDL cholesterol. more…

Genetic study suggests CRP not causal in atherosclerosis

17 Jan, 09 | by Alistair Lindsay

Increased levels of C-Reactive Protein (CRP) are associated with an increased risk of ischaemic heart and cerebrovascular disease. But is CRP a causal factor in atherosclerosis development or merely a marker for ischaemic vascular disease?  Evidence to suggest a role for CRP in the pathogenesis of atherosclerosis is predominantly from epidemiological studies. These have consistently observed an association between elevated CRP and cardiovascular events. This relationship has the same statistical strength as for other cardiovascular risk factors such as hypertension and diabetes mellitus. However statistical strength does not imply causality as alternative explanations may be offered by reverse causality or other confounding factors. ‘Mendelian randomisation’ – the random assortment of genes that occurs during gamete formation – provides a relatively unbiased method in assessing whether risk factors that have a genetic component are causally related to clinical outcomes. more…

JUPITER puts primary prevention into new orbit

17 Jan, 09 | by Alistair Lindsay

Current guidelines recommend statin treatment for patients with known vascular disease, diabetes or elevated lipid levels. Yet half of myocardial infarctions and strokes occur in apparently healthy individuals with levels of low density lipoprotein (LDL) cholesterol that are below current threshold levels for treatment. High sensitivity C-reactive protein (CRP) is an inflammatory biomarker which can predict future vascular events and improves risk classification independently of LDL cholesterol level. Statin therapy has been shown to decrease CRP levels. However a question remains to be answered: Would healthy individuals with levels of LDL cholesterol below current treatment levels but with elevated levels of high sensitivity CRP benefit from statin therapy? more…

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