Routine testing of hs-CRP in women with heart disease is controversial, says Mayo Clinic cardiologist

For women concerned about heart disease, routine testing of high-sensitivity C-reactive protein (hs-CRP) is controversial, says Thomas Behrenbeck, M.D., Ph.D., a Mayo Clinic cardiologist, in an interview in the February issue of Mayo Clinic Women's HealthSource.

CRP is a marker for inflammation within the body and has been promoted as a screening test for coronary artery disease. Inflammation can play an important role in atherosclerosis, the process in which fatty deposits build up in coronary arteries. Interest in hs-CRP originated when studies found that patients with unstable angina or chest pain had high levels of this marker. Researchers found that hs-CRP could be used to predict who would go on to have a heart attack. But other studies have shown that hs-CRP isn't a predictor of heart attack risk in people without symptoms of heart disease.

"If hs-CRP is elevated, it is worrisome because it tells you there is inflammation in the body," says Dr. Behrenbeck. "But it doesn't mean the inflammation is related to coronary artery disease." Inflammation can be a response to any type of injury or infection. People who have rheumatoid arthritis have very high levels of hs-CRP. Elevated levels also can be caused by a bruise or a minor surgical procedure such as a tooth extraction.

For now, says Dr. Behrenheck, there's no good role for hs-CRP screening in patients without symptoms of coronary artery disease. "We've been unable to determine if knowing your hs-CRP level is helpful beyond all of the other traditional risk factors -- such as high blood pressure, diabetes, smoking and high cholesterol," he says.

He advises women to continue to focus on the traditional risk factors. Controlling these risk factors is especially important postmenopause, when a woman's risk of coronary heart disease increases.