That a substance called C-reactive protein (CRP) is a reliable predictor of heart disease has been known for a few years. The evidence has gotten much stronger now that CRP may be every bit as important as cholesterol in the diagnosis and treatment of heart disease. A study published in 2002 already had shown that CRP was a better marker for heart attack and stroke than cholesterol. With the dawn of the new year, two studies in the New England Journal of Medicine have shown that lowering the levels of CRP in the circulating blood can slow down the progression of atherosclerosis and prevent cardiovascular events and heart-related deaths.

As with any clinical investigation, even though these studies have caveats, their impact indicated that a sea change is underway in cardiology. After decades of focusing on cholesterol and its role in blocking arteries, researchers have provided evidence that CRP --a measure of inflammation in the arteries and, in fact, throughout the body-- is a major risk factor in its own right.

The key finding is that patients with heart disease who were given statins to lower cholesterol also experienced a reduction in CRP levels. As such, statins packed a double wallop.

While these findings apply only to patients already suffering from heart disease, it is a reasonable extension of these findings that lowering CRP in healthy patients with normal levels of cholesterol but above-average levels of CR-P can reduce their risk of heart disease. After all, roughly one-half of all people who surfer a heart attack have normal cholesterol levels. Therefore, it is critical to monitor CRP levels, which tan be tested straightforward and inexpensively.

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