[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.
Schwarzer
Ruth
R
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.
Schnell-Inderst
Petra
P
Grabein
Kristin
K
Göhler
Alexander
A
Stollenwerk
Björn
B
Grandi
Norma
N
Klauss
Volker
V
Wasem
Jürgen
J
Siebert
Uwe
U
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