Is HS-CRP a useful screening tool to identify patients at risk for cardiovascular disease - Assignment Example

SECT NUMBER Objective: To evaluate the available literature on the efficiency of high sensitivity C- reactive protein (hsCRP) as a screening tool to identify patients at risk for cardiovascular disease (CVD). Data Sources: Selected research articles are compiled from Blue Cross and Blue Shield Association, Nutrition & Metabolism, International Journal of Applied Biology and Pharmaceutical Technology, International Scholarly Research Network, International Journal of Emergency Medicine, and The American Geriatrics Society, issued starting from 2010 up to the present. Data Summary: Although research methods, used in determining the value of hsCRP as a screening tool for cardiovascular disease risk, increased in sophistication, obtained results still do not perfectly coincide with each other. Apparently, these research studies share the common premise of the inflammatory pathogenesis of CVD. Differences in the results can be attributed to the sample size, race, age and gender of subjects of research. In addition, some research studies concentrate only on a specific cardiovascular alteration such as acute coronary syndrome (ACS), myocardial infarction (MI), or coronary heart disease (CHD). Conclusions: The inconsistency among various research data implies that hsCRP is a useful screening tool for CVD risk based on the pathophysiologic causality. However, its conclusive claims face intense debates when used single-handed. Question Is hsCRP a useful screening tool to identify patients at risk for cardiovascular disease? Background Cardiovascular diseases are the number one cause of death in the United States. Risk factors may include family history, high fat diet and obesity, cigarette smoking, physical inactivity, and personal history of major illnesses, such as diabetes mellitus, high BP, heart disease, and thrombophlebitis, and numerous other reasons. In this regard, early detection and treatment is considered to be of primary priority in the successful management of cardiovascular diseases. Screening tools need to be standardized to prevent unnecessary healthcare cost and improve patient care outcomes. Meanwhile, recent studies showed that the development of cardiovascular diseases is associated with inflammatory processes as seen in atherothrombosis and myocardial ischemia. Clinical evidence reported in the professional literature on the link between CVD risk factors and innate chemical substances that initiate future episodes of CVD. In fact, these novel biomarkers have equal significance with established CVD risk factors in screening at-risk individuals1. Consequently, highly sensitive C-reactive protein (hsCRP) was the most- studied marker of inflammation related to cardiovascular diseases risk factors. Changes in CRP values are directly correlated with inflammatory states and are regulated through a series of chemical interactions as seen in interleukin cascades. Essentially, most inflammatory and chronic conditions result in CRP elevations. The actual critical link attributed to CRP is on the inflammatory reaction preceding CVD onset2. It was proposed that CRP initiates endothelial cell activation and dysfunction which in turn cause substantive effects on vascular smooth muscle cells and neointimal formation. This would directly affect monocyte and macrophage activity as well as matrix metalloproteinase function7. Measurements of hsCRP are considered in numerous studies of individuals currently having or with known risk factors of having cardiovascular diseases. On the other hand, the use of hsCRP is found to be controversial since any inflammatory process can produce serum elevations. For instance, elevations are observed even with hypertension, infection, and smoking. Thus, the circumstances underlying CRP involvement in CVD need to be precisely determined1. Establishing reliability of hsCRP as a screening tool necessitates a comprehensive meta- analysis of large- scale epidemiologic studies. Apparently, improvements in precision at lower levels of CRP can be achieved when the range of values constitute up to five intervals. Only upon establishment of this standard range of values that CRP measurements can be applied to individual patients2. In this literature review, the data from selected empirical studies is taken from Blue Cross and Blue Shield Association, Nutrition & Metabolism, International Journal of Applied Biology and Pharmaceutical Technology, International Scholarly Research Network, International Journal of Emergency Medicine, and The American Geriatrics Society. Major considered points are the reliability of hsCRP as a screening tool in cardiovascular diseases, analysis of clinical trials, and their research implications based on the data gathered. Literature Review A case control study considered the relationship between hsCRP and cardiac markers among individuals who suffered from acute myocardial infarction3. The study involved a total of 60 subjects of 50-68 years old with a particular exclusion of individuals with systemic conditions, like thyroid disorders, acute infections ( Read More