The importance of CRP

Full of CRP  

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No one yelled, “Stop the presses!” No urgent “breaking news” bulletins came across the newswires. Nevertheless, a new era dawned recently when the medical mainstream finally gave its official stamp of approval to a cardiovascular risk factor that HSI members have known about for years:
C-reactive protein (CRP).

CRP is produced by the liver in response to inflammation, and is
considered by many to be a more reliable marker for cardiovascular complications than cholesterol levels. In a nutshell: Atherosclerosis (narrowing of the arteries) requires inflammation to take place. If CRP is elevated, the stage is set for potential heart problems.

So why the sudden acknowledgement of CRP’s dangers? Simple: Two recent studies indicate that statin drugs may lower CRP.

See? All that was needed was a little motivation (like increased sales of the medical mainstream’s most beloved product) to recognize the importance of CRP.

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New England connection
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The New England Journal of Medicine (NEJM) published both of the new CRP studies in January; one from the Cleveland Clinic, and one from Brigham and Women’s Hospital and Harvard Medical School.

In the first, researchers led by the Cleveland Clinic drew their
conclusions from a trial I told you about in 2003 in which about 500
patients with coronary disease were given either 80 mg of Lipitor per day or 40 mg of Pravachol per day for 18 months. (According to the New York Times, Pfizer – the maker of Lipitor – sponsored the original study which tested these two statin drugs head-to-headif you can call a 100 percent difference in dosage “head-to-head.”)

Using an ultrasonography technique on each subject in the study, the Cleveland team found that atherosclerosis progression was reduced, while CRP levels dropped by 36 percent in the high dose Lipitor group and five percent in the low dose group. (By the way: Three of the ten researchers on this new study were affiliated with Pfizer.)

In a press release from the Cleveland Clinic, lead researcher Steven Nissen, M.D., stated: “Until now we did not have evidence that targeting CRP could reduce disease burden.”

Actually, we did have evidence. We’ve had it for years. It just wasn’t
tied in with statin use.

If Dr. Nissen will check his back issues of the New England Journal of Medicine (Vol. 347, No. 20, 11/14/02), he’ll find a study that followed more than 27,000 women for eight years to compare CRP and LDL in the prediction of cardiovascular events. (HSI members may recall this study from the e-Alert “Burst of Inflammation” 11/21/02.)

Researchers found that subjects with the highest CRP levels were more than twice as likely to experience an adverse cardiovascular event than those with the lowest levels of CRP. When subjects with high CRP levels were compared to subjects with high LDL cholesterol, the data suggested that the CRP reading is a more reliable predictor of CV events.

Furthermore, subjects with high CRP were found to be at higher risk, EVEN WHEN THEIR LDL WAS LOW.

This is completely contrary, of course, to what conventional mainstream thinking on cholesterol would have us believe.

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Pfizer-free
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The other recent CRP study that appeared in the January NEJM also found statins to be effective in lowering CRP among more than 3,700 subjects with acute coronary syndromes. But here’s the comment that jumped out at me from the conclusions of this study: “Patients who have low CRP levels after statin therapy have better clinical outcomes than those with higher CRP levels, regardless of the resultant level of LDL cholesterol.”

So, REGARDLESS of what the LDL may be, lower CRP is associated with a better clinical outcome. There’s your headline right there. Not only is CRP becoming a star, but it appears that the mainstream’s old trooper – LDL cholesterol – may be getting shoved off the stage.

Of course the REAL star being promoted here (as usual) is statins. But is statin therapy necessary to lower CRP? Absolutely not.

In the e-Alert “Fuel Crisis” (5/24/05), I told you about a study that
examined the dietary and medical records of more than 3,900 men and women to assess the association between dietary fiber intake and CRP levels.

Comparing subjects who had the highest fiber intake with those who had the lowest, researchers found that CRP levels were lowest among subjects with fiber-rich diets. How fiber intake affects inflammation is still poorly understood, but previous studies have shown that soluble fiber intake may have a preventive effect against heart disease. Soluble fiber sources include fruits, vegetables, nuts, seeds, legumes, oats and barley.

And there’s another common nutrient that can help lower CRP. In the e-Alert “Putting the C in CRP” (4/28/04), I told you about research reported in the Journal of the American College of Nutrition in which vitamin C cut CRP levels by nearly 25 percent.

As you might guess, no Pfizer researchers were involved with either of these studies.

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and another thing

When you prepare fish, you’ll be doing yourself a favor if you bake or broil. But you’ll be doing an even bigger favor if you avoid frying.

In the e-Alert “David Beats Goliath Again” (5/15/03), I told you about a University of Washington study that demonstrated how those who regularly ate tuna and other baked or broiled fish three or more times per week had a significantly lower risk of coronary heart disease (CHD) than those who ate the same fish infrequently. The same study showed that those who regularly ate fried fish had a higher risk of both heart attack and death due to CHD.

A new study, from the Harvard School of Public Health, has come to remarkably similar conclusions regarding fish preparation and stroke risk among older people.

Using food frequency questionnaires and medical records, the Harvard team tracked the diet and stroke rates of more than 4,700 older adults (ages 65 to 98) over a period of 12 years. The researchers found:

*Those who ate baked or broiled fish one to four times each week
had a 28 percent lower risk of ischemic stroke, compared to those who ate a similar fish meal less than once each month

*Those who ate baked or broiled fish more than five times each
week lowered their comparative risk by more than 30 percent

*Subjects who reported eating fried fish more than once each week had a 44 percent HIGHER risk of stroke compared to those who ate fried fish less than once each month

*Ischemic stroke risk was increased by 13 percent for each
serving of fried fish consumed each week

Although the exact mechanisms that make baked or broiled fish a far healthier choice than fried are still open to speculation, the increased intake of omega-3 fatty acids are believed to play an important role.

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Sources:

“Statin Therapy, LDL Cholesterol, C-Reactive Protein, and Coronary Artery Disease” The New England Journal of Medicine, Vol. 352, No. 1, content.nejm.org

“C-Reactive Protein Levels and Outcomes after Statin Therapy, Vol. 352, No. 1, content.nejm.org

“Two New Studies Show Reduction in Both C-Reactive Protein and Cholesterol Required to Control Heart Disease” PRNewswire, 1/5/05, prnewswire.com

“Fish Consumption and Stroke Risk in Elderly Individuals: The
Cardiovascular Health Study” Archives of Internal Medicine, Vol. 165, No. 2, ncbi.nlm.nih.gov

“Weekly Baked Fish Cuts Stroke Risk in Elderly” utraIngredients.com, 1/25/05, nutraingredients.com