The most important heart disease risk test you’ve never heard of

What is hsCRP, and how can it help predict your risk of developing heart disease?

Did you know that high levels of inflammation in the body are linked to a higher risk of heart disease, including coronary artery disease, heart attack and heart failure? If you and your primary care provider are evaluating your risk of developing heart disease, looking for high inflammation is an important piece of the puzzle – and that’s where hsCRP comes in.

The hsCRP abbreviation stands for “high sensitivity C-reactive protein.” It’s a laboratory test that measures the level of C-reactive protein, or CRP, in the blood. Increased CRP functions like a warning light, signaling inflammation somewhere in the body. While the hsCRP test doesn’t mean a person has heart disease today, it is a good marker of inflammation levels that can lead to heart disease.

“Primary care providers are increasingly using hsCRP to assess cardiovascular risk in people who don’t already have known heart disease,” said preventive cardiologist Jared Spitz, MD, Director of Inova Schar Heart and Vascular’s Advanced Lipid Program.

How hsCRP results can help predict heart disease risk

You likely already know that a person’s blood cholesterol level is an important risk factor for heart disease. That’s because cholesterol is the major driver of plaque buildup in the arteries. Think of inflammation in a similar way. A person’s hsCRP level, when considered with a person’s cholesterol levels, can provide even better information about the risk of developing heart disease. Here is how it breaks down:

• People with very high cholesterol and a normal hsCRP are at risk
• People with normal cholesterol and high hsCRP are also at risk
• If both hsCRP and cholesterol are elevated, people are at higher risk

If a patient’s hsCRP is above 10mg/L, something is going on somewhere in the body – but it’s not necessarily a heart problem and should prompt your primary care doctor to try to identify possible causes. It could be an inflammatory autoimmune condition, an infection or even joint inflammation. In an otherwise healthy patient, an hsCRP of more than 10 mg/L should be rechecked in in two to three weeks. If it’s still high, it’s time to take action.

My doctor says my hsCRP is high – what should I do?

The first plan of action is always lifestyle changes. In this case, individuals would want to focus on decreasing inflammation. This can be done in many ways including:

• Healthy diet – the Mediterranean and DASH diets are anti-inflammatory
• Exercise is anti-inflammatory, so 150 minutes of moderate activity or 75 minutes of vigorous activity per week can help
• Smoking is highly inflammatory, in addition to the other damage it causes throughout the body, so quitting can really help
• Losing extra weight is helpful, as obesity increases inflammation as well

After six months of lifestyle changes, if the individual’s hsCRP is normal (in addition to positive changes in cholesterol and blood pressure levels), the person may not need medication. However, if after six months the patient has borderline cholesterol numbers and an hsCRP above 2mg/L, it is probably time to think about starting to take a statin to reduce heart disease risk by lowering cholesterol, inflammation or both. Note: hsCRP levels should be rechecked before starting or changing medications.

For patients who are already on a statin, and whose cholesterol is reduced with lifestyle changes and medication, the picture becomes more complicated if the patient’s hsCRP is still high. It could, for example, be time to increase the dose of the statin or consider additional medication options. Talk with your primary care provider about the options.

When it might be time to see a cardiologist

There is no hard-and-fast recommendation to see a cardiologist if your hsCRP reaches a certain number. However, patients whose cholesterol, blood pressure and hsCRP numbers are a bit outside normal range despite lifestyle changes could benefit from talking with a preventive cardiology specialist.

“Where risk is uncertain, it’s a good idea to send a patient to preventive cardiology, because we have more refined tools for risk stratification and we see patients like this every day,” Dr. Spitz said. “Anytime there’s a concern or enough of a question about a patient, we’re always happy to see people in preventive cardiology.”

Learn more about Inova’s preventive cardiology services.