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Of current inflammatory markers identified, hs-CRP has the analyte and assay characteristics most conducive for use in practice.
A Writing Group convened by the American Heart Association and the Centers for Disease Control and Prevention (Pearson et al, 2003) endorsed the optional use of hs-CRP to identify persons without known cardiovascular disease who are at intermediate risk (10 to 20 % risk of coronary heart disease over the next 10 years).
An assessment by the Blue Cross Blue Shield Association Technology Evaluation Center (BCBSA, 2005) provided a framework for the evaluation of the potential clinical utility of putative risk factors for cardiovascular disease.
The assessment explained that the strongest evidence of the value of such a test is direct evidence that its measurement to assess cardiovascular disease risk results in improved patient outcomes.
The USPSTF stated that clinicians should continue to use the Framingham model to assess CHD risk and guide risk-based preventive therapy (USPSTF, 2009). An elevated CRP level may be indicative of inflammation (nonspecific location).
hs-CRP can detect the slight elevations in serum CRP that are associated with coronary artery disease (CAD), which can be within the normal range.
Of patients with CHD, 85 % of women and 81 % of men had at least 1 conventional risk factor.
However, the Writing Group noted that the utility of hs-CRP in secondary prevention is more limited because current guidelines for secondary prevention generally recommend, without measuring hs-CRP, the aggressive application of secondary preventive interventions.In the 1 study that assessed non-fatal MI, at least 1 major risk factor was present in 87 % of women and 92 % of men age 40 to 59.In another large study (Khot et al, 2003), researchers analyzed data from more than 120,000 patients enrolled in 14 randomized controlled trials (RCTs) to determine the prevalence of baseline conventional risk factors among CHD patients.Non-traditional risk factors for coronary heart disease (CHD) are used increasingly to determine patient risk, in part because of an assumption that many patients with CHD lack traditional risk factors (e.g., cigarette smoking, diabetes, hyperlipidemia, and hypertension).Hackman and Anand (2003) summarized existing evidence about the connection between atherosclerotic vascular disease and certain nontraditional CHD risk factors (abnormal levels of C-reactive protein [CRP], fibrinogen, lipoprotein(a), and homocysteine [Hcy]).