Heart disease is the number one killer of women. The incidence of heart disease in women is lower than men until women go through menopause. New research has shown that CRP or C-reactive protein is an important marker for heart disease and can help identify women who were previously thought to be low risk for cardiovascular disease. C-reactive protein is a substance produced by the liver in response to infection and other inflammatory conditions.
The Women’s Health Study showed that C-reactive protein was a strong independent risk factor for heart disease. C-reactive protein and LDL is better predictor of heart disease than LDL cholesterol alone. Women with the highest risk had both elevated CRP and LDL cholesterol. While more research is needed, many health care professionals agree that adding a routine panel screening for women for heart disease can identify more women who need cholesterol-lowering medications such as statins.
Women are considered high risk that are over 55, have diabetes, elevated blood pressure, obesity, and family history of heart disease. Smokers and women with sedentary life style are also considered as high risk. Women with chronic kidney disease and women who are menopausal are also at higher risk for heart disease.
A new scoring system called the Reynolds Risk Score, which incorporates C-reactive protein, was more predictive of heart disease than standard risk assessment. The Reynolds Risk Scoring system is only used for women without diabetes or previous heart disease. The Reynolds Risk Score includes assessing a person’s age, gender, family history of early heart disease, smoking history, blood pressure, and C-reactive protein and cholesterol levels. These factors are quantified and give a statistical analysis of the likelihood of having a heart attack, stroke, or other major heart disease in the next 10 years.
Statins such as Zocor or Lipitor are medications that can reduce cholesterol levels and have been shown to reduce heart disease. Frequently recommended to males, statins are increasingly being recommended to women to reduce their risk of heart attacks and strokes.
In this study many women without elevation in LDL cholesterol subsequently developed heart disease. If CRP had been a routine part, many of these women would have been offered cholesterol-lowering medication such as statins. Statin therapy along with weight loss, low cholesterol diet, and exercise have been shown to markedly lower heart disease.
It is not known for sure how CRP is related to heart disease. Recent theories suggest that the elevated cholesterol in a woman’s blood is deposited in blood vessels. These deposits form plaques and narrow the blood vessels. C-reactive protein binds to LDL, the bad cholesterol, making it easier to enter the cholesterol plaques. The cholesterol-laden plaques cause irritation or inflammation of the lining of the blood vessels also known as endothelium.
The immune system in response to the damaged endothelium releases inflammatory proteins that can cause clots in the damaged narrowed blood vessels. The blood clots block the flow of blood and prevent oxygen from getting to tissue downstream from the clot. If the blood clot occurs in the heart muscle, a woman has a heart attack. If it occurs in the brain, a stroke occurs. If it occurs in the legs, severe pain in the legs can result. Severe leg pain and swelling can be signs of a blood clot and would require immediate medical attention.
If CRP is elevated, the test will need to be repeated because a recent infection or chronic infection makes the test inaccurate for predicting heart disease. However, if no other cause is identified, CRP is a marker for elevated risk of heart disease. Certain women will benefit from risk stratification with CRP to prescribe the right drug treatment. Drug treatment and lifestyle changes can keep your heart healthy.
Until further research is completed, all health care professionals agree on basic principles to reduce heart disease. These include eating a well-balanced, low fat, low calorie diet; don’t start smoking or quit smoking and exercise regularly. It is also important to treat high cholesterol. Following your C-reactive protein may also become an important tool for patients and doctors to predict or possibly prevent a heart attack or stroke in your future.
Dr. Hardy practices obstetrics and gynecology at Atlantic Ob/Gyn with locations in Va. Beach and Chesapeake. Please call 757-463-1234 or visit www.atlanticobgyn.com.