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Cardiovascular Risk Assessment Using High Sensitivity C-Reactive Protein (hs-CRP) & Serum Cholesterol Screening

Purpose: To estimate cardiovascular disease risk using high sensitivity C-reactive protein and serum cholesterol levels based on the algorithm of Rifai and Ridker.

Description

Rifai and Ridker proposed an algorithm for predicting cardiovascular risk based on high sensitivity C-reactive protein levels and cholesterol screening. Serum measurements were separated based on quintiles seen for the population. The authors are from Bringham and Women's Hospital and Harvard Medical School in Boston.


 

Laboratory testing:

(1) high sensitivity C-reactive protein (hs-CRP) with results in mg/L

(2) serum total cholesterol in mg/dL or mmol/L

(3) serum HDL cholesterol in mg/dL or mmol/L

 

total cholesterol to HDL cholesterol ratio =

= (total cholesterol in mg/dL) / (HDL cholesterol in mg/dL)

 

Test

Finding

Quintile

high sensitivity CRP

0.1 – 0.7 mg/L

1

 

0.7 – 1.1 mg//L

2

 

1.2 – 1.9 mg/L

3

 

2.0 – 3.8 mg/L

4

 

3.9 – 15.0 mg/L

5

TC-to-HDLC ratio with gender

< 3.4 in female

1

 

3.4 – 4.1 in female

2

 

4.1 – 4.7 in female

3

 

4.7 – 5.8 in female

4

 

> 5.8 in female

5

 

< 3.4 in male

1

 

3.4 – 4.0 in male

2

 

4.0 – 4.7 in male

3

 

4.7 – 5.5 in male

4

 

> 5.5 in male

5

after Figure 2A and 2B, page 29

 

where:

• The hs-CRP level overlaps at 0.7 between the 1st and 2nd quintile.

• The TC-to-HDL cholesterol ratio overlap at several break points (4.0, 4.1, 4.7).

TC-to-HDLC Ratio

hs-C-reactive protein

Relative Risk

1

1

1.0

 

2

1.2

 

3

1.4

 

4

1.7

 

5

2.2

2

1

1.4

 

2

1.7

 

3

2.1

 

4

2.5

 

5

3.0

3

1

2.0

 

2

2.5

 

3

2.9

 

4

3.5

 

5

4.2

4

1

2.9

 

2

3.5

 

3

4.2

 

4

5.1

 

5

6.0

5

1

4.2

 

2

5.0

 

3

6.0

 

4

7.2

 

5

8.7

after Figure 2C, page 29

 

Limitations:

• The high sensitivity CRP assay used should be compared in the patient population to provide the same quintiles.

 


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Specialty

Objective

ICD-10