A new marker, showing the danger of heart attacks and strokes, has replaced cholesterol. This revolution is quiet; even experts do not speak of it loudly. Patients know very little about it, and if they have heard, they do not grasp its significance. Yet, it is unfolding before our eyes.
Cholesterol testing has not lost its value, but the determination of the so-called high-sensitivity C-reactive protein (hsCRP) is more informative. For brevity, we will simply call it CRP.
It’s All About Inflammation
“Data accumulated over the last two decades shows that the biomarker called C-reactive protein signals the presence of low-grade inflammation and is a superior predictor of cardiovascular disease risk than cholesterol,” reports The Conversation. This serious online publication covers science topics, with articles written by academics alongside journalists—to ensure they are more easily understood by the general public. Therefore, this assertion can be trusted.
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A very important victory on this front occurred this autumn when the American Heart Association (AHA) released its scientific statement, “Inflammation and Cardiovascular Diseases.” “Recently, increasing attention has been paid to the decisive role of inflammation in the pathogenesis and clinical outcomes of cardiovascular diseases,” the document states. “Specifically, residual inflammation, measured by high-sensitivity C-reactive protein, continues to be a strong prognostic factor for recurrence, even in patients receiving statins. Similarly, the presence of elevated hsCRP levels in outwardly healthy individuals suggests they are in a heightened risk group.”
How Heart Attacks and Strokes Develop
Let’s try to explain all this in simple terms for better clarity. Especially since Doctor of Medical Sciences, Head of the Emergency Cardiology Department at the Central Clinical Hospital, and Chief Cardiologist of the Administration of the President of the Russian Federation, Nikita Lomakin, has previously discussed this with us.
Until now, the development of myocardial infarction has sometimes been depicted as the blockage of a vessel supplying blood to the heart by an atherosclerotic plaque. It gradually grows, accumulating cholesterol and calcium, eventually clogging it and leading to a heart attack.
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In reality, everything happens differently. Heart attacks can be triggered even by small plaques that only slightly obstruct the vessel. The main thing is that they can become inflamed, like a common skin pimple (as happens with infections, inflammations, or stress). This results in swelling, and defects appear on the plaque’s surface. “The body is fooled and perceives these as holes in the vessel that need closing,” explains Nikita Lomakin. “A clot forms, further narrowing the vessel lumen, which manifests as chest pain—angina. The clot grows, and a genuine heart attack develops. Sometimes there is an extreme situation when the plaque ruptures: a large clot forms very quickly, leading to a heart attack. These mechanisms underpin 70-80% of all heart attacks.” The processes occurring during strokes are similar.
Recalling Pandemic Lessons
As we can see, inflammation plays a key role here, and an elevation in CRP signals its activity. And this is the opportune moment to recall the recent Covid pandemic. Have you forgotten that heart attacks and strokes occurred in many people for several months after coronavirus infection? This happened not only in the elderly but also in quite young and seemingly healthy individuals (as mentioned in the AHA statement above). Well, most often, this was linked to inflammation of the inner lining of the arteries—the endothelium. Cardiologist, Honored Doctor of the Russian Federation, Doctor of Medical Sciences, Professor Yuri Vasyuk told us about this.
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Plaques can also become involved in this inflammation. And as you already understand, this is a direct path to heart attacks and strokes. Incidentally, these complications arise in exactly the same way in the first few months after the flu. And imagine, many people could have avoided them if they had monitored their level of inflammation in the body, guided by CRP.
“After Covid, inflammation can persist for a long time, increasing the risk of thrombosis,” Yuri Vasyuk noted. “The more active it is, the more severe the disease and the poorer the prognosis. A person who has recovered from Covid may not feel this inflammation; its presence is indicated by an elevation of high-sensitivity CRP in the blood.”
Yuri Alexandrovich explained that optimally, CRP should be less than 1.0 mg/L; at this level, the risk of developing myocardial infarction and stroke is low. A reading between 1 and 3 mg/L indicates a medium risk level, and above 3 mg/L signifies an elevated risk.
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So, what follows from all this?
Firstly, after serious infections like Covid and the flu, it would be beneficial to check CRP to understand if additional efforts are needed to protect the vessels.
Secondly, the test should also be done when checking cholesterol for the first time. Even if LDL (“bad cholesterol”) is normal, but CRP is persistently high, this is a reason to combat it. In such cases, statins are sometimes even prescribed, as they, among other things, mitigate vessel inflammation.
Thirdly, for patients already suffering from heart and vessel diseases, CRP is a powerful predictor of new problems (heart attacks, strokes, angina, etc.).
And what about cholesterol, should we forget it? No, it still matters. Elevated “bad cholesterol” indicates a risk of vessel damage over a long period. However, for predicting heart attacks, strokes, and the worsening of heart pathology, CRP is more indicative.
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