Prognostic value and clinical effectiveness of high sensitivity C-reactive protein as a marker in primary prevention of major cardiac events

To compare the predictive value and the clinical effectiveness of additional high sensitivity C-reactive protein (hs-CRP) screening as opposed to traditional risk factor screening alone as a strategy of primary prevention of coronary artery disease (CAD). Following a comprehensive search of 26 electronic databases by DAHTA DIMDI, a systematic review was performed in accordance with international standards of evidence based medicine. Eight publications on risk prediction and one study addressing clinical decision-analytic modelling were included in the assessment. The adjusted relative risk of a high hs-CRP level (> 3 mg/L) for myocardial infarction, cardiac related death, and cardiovascular events ranged from 0.7 to 2.47 (p < 0.05 in 4 of 7 studies). The area under the receiver operating characteristic curve (AUC) increased by 0.00 to 0.027 when hs-CRP was added to the prediction models (4 of 7 studies statistically significant with p < 0.05). Based on a published decision-analytic model examining hs-CRP screening, the gain in life expectancy due to statin therapy in individuals with elevated hs-CRP was similar when compared to patients with hyperlipidaemia. Nonetheless, evidence on many model parameters was limited. Screening with hs-CRP in addition to traditional risk factors improves risk prediction. However, the incremental effect is moderate and the clinical relevance remains unclear.