Evaluation of C-reactive protein measurement for assessing the risk and prognosis in ischemic stroke: a statement for health care professionals from the CRP Pooling Project members.
OBJECTIVE
Several studies have shown, in different populations, that modest elevation of plasma C-reactive protein (CRP) in the range seen in apparently healthy individuals is a strong predictor of future vascular events. Elevated plasma CRP concentrations are also associated with an increased risk of cerebrovascular events and an increased risk of fatal and nonfatal cardiovascular events in ischemic stroke patients. These epidemiological and clinical observations suggest that determination of plasma CRP concentrations could be used as an adjunct for risk assessment in primary and secondary prevention of cerebrovascular disease and be of prognostic value. The aim of this review is to summarize the evidence for CRP as an independent predictor of cerebrovascular events in at-risk individuals and ischemic stroke patients and to consider its usefulness in evaluating prognosis after stroke.


RESULTS
CRP fulfils most of the requirements of a new risk and prognostic predictor, but several issues await further confirmation and clarification before this marker can be included in the routine evaluation of stroke patients and subjects at risk for cerebrovascular disease. Potentially important associations have been established between elevated plasma CRP concentrations and increased efficacy of established therapies, particularly lipid-lowering therapy with statins.


CONCLUSIONS
At present, there is not sufficient evidence to recommend measurement of CRP in the routine evaluation of cerebrovascular disease risk in primary prevention, because there is insufficient evidence as to whether early detection, or intervention based on detection, improves health outcomes, although shared risk of cardiovascular disease indicates this may be of value. In secondary prevention of stroke, elevated CRP adds to existing prognostic markers, but it remains to be established whether specific therapeutic options can be derived from this.
Di Napoli
Mario
M
San Camillo de Lellis General Hospital, Rieti, Italy. mariodinapoli@katamail.com
Schwaninger
Markus
M
Cappelli
Roberto
R
Ceccarelli
Elena
E
Di Gianfilippo
Giacinto
G
Donati
Cristina
C
Emsley
Hedley C A
HC
Forconi
Sandro
S
Hopkins
Stephen J
SJ
Masotti
Luca
L
Muir
Keith W
KW
Paciucci
Anna
A
Papa
Francesca
F
Roncacci
Sabina
S
Sander
Dirk
D
Sander
Kerstin
K
Smith
Craig J
CJ
Stefanini
Alessandro
A
Weber
Daniela
D
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D015415:Biomarkers; D002545:Brain Ischemia / Q000097:blood* / Q000175:diagnosis*; D002097:C-Reactive Protein / Q000096:biosynthesis*; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis; D002561:Cerebrovascular Disorders / Q000097:blood / Q000175:diagnosis; D002986:Clinical Trials as Topic; D005260:Female; D005500:Follow-Up Studies; D017408:Guidelines as Topic; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007249:Inflammation; D008055:Lipids / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012306:Risk; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy
D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D002097:C-Reactive Protein; D001241:Aspirin