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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Institut für Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Information Systems and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Osterreich.
Ruth
R
Schwarzer
Petra
P
Schnell-Inderst
Kristin
K
Grabein
Alexander
A
Göhler
Björn
B
Stollenwerk
Norma
N
Grandi
Volker
V
Klauss
Jürgen
J
Wasem
Uwe
U
Siebert
D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control; D016208:Databases, Factual; D019317:Evidence-Based Medicine / Q000592:standards; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control; D011237:Predictive Value of Tests; D011322:Primary Prevention
D015415:Biomarkers; D002097:C-Reactive Protein