What is the cardio C-reactive (hs CRP) protein test?
Cardio C-reactive protein also known as high sensitive C-reactive protein (hs CRP) is a simple blood test. According to Dr. Bikram Kesharee Mohanty, Senior Consultant Cardio-Thoracic & Vascular Surgeon (Adult & Pediatric), Visiting Consultant at National Heart Institute, “CRP or the standard CRP is an inflammatory marker which means whenever there is an infection anywhere in the body, the CRP level in the blood is raised, hs CRP is more sensitive than the standard CRP. In an otherwise healthy human being, if the hs CRP level is high, it is an indicator or an alarm that the individual has got more possibilities to have blockages in the heart arteries, heart attack, sudden heart arrest, stroke or arterial blockages of arms and legs in the future.”
Dr. Vivek Chaturvedi, Professor & HOD, Cardiology, Amrita Hospital, Faridabad further adds, “Cardio C-Reactive Protein or HSCRP is a test that has recently come into prominence, and is available as part of various investigation packages. It is a marker of low level chronic or long-standing inflammation. Inflammation is a reaction of our body against infection, stress, certain auto-immune diseases like rheumatoid arthritis etc. When after an insect bite we see red spots develop on our skin, that is due to inflammation. Inflammation is appropriate in the short term, but can be harmful for our bodies, when present for longer duration. A low level of long-standing inflammation in the heart has been linked to increased problems of heart attack, sudden death, and requirement of angioplasty or bypass etc. People who have persistently high hsCRP have been found to be at higher risk for heart disease as compared to those who do not have elevated hsCRP.”
He further states, “Cardio C Reactive Protein or hsCRP is only one part of the jigsaw puzzle which is heart health. It should not be considered in isolation. Some studies have found that high levels of hsCRP increase the risk even in absence of other heart disease risk factors, but this is still controversial. However, we are quite confident that the risk due to other heart disease risk factors (like high BP, diabetes) increases even more in presence of increased hsCRP. It is very important to remember that any recent infections can cause CRP & hsCRP to become elevated for several weeks. So, it cannot be interpreted if you had a recent infection or if you have some other autoimmune diseases which can cause CRP to become elevated. Several healthy people have approached me for consultation after getting anxious due to a bold hsCRP value that was a part of the so called ‘whole body tests’, that have become so common since the Covid pandemic! It definitely doesn’t mean that you are going to have a heart attack! Always, the results of hsCRP, just like any other test, should be interpreted in a clinical context.”
What do the numbers say?
High numbers indicate an otherwise healthy human is more prone for heart diseases like arterial blockages, heart attack, sudden heart arrest, stroke and peripheral arterial diseases in the future.
According to Dr. Anupam Goel, Director – Interventional Cardiology, Max Hospital, Saket, “Along with other risk factors and lipid panels, high Hs-CRP could be a marker for high CVD risk even in apparently healthy individuals and could be the indication of one’s heart health. When hs CPR is high, it should be repeated twice, optimally two weeks apart (in patient’s free of infection or acute illness) to confirm that person has persistent low levels of inflammation. High hs CRP is a marker of inflammation only and not specific for predicting heart disease. These values are only a part of total evaluation for heart disease and need to be considered with high cholesterol, sugar, hypertension, smoking and other CVD risk factors.”
Elevated CRP levels are almost always associated with other risk factors for heart disease including smoking, obesity, inactive lifestyle, high cholesterol, high blood pressure, diabetes, metabolic syndrome (a combination of high blood pressure, high blood sugar abnormal lipid levels, and excess fat).
Regular screening is important post 40
People above the age of 40 should get their regular yearly heart checkup which includes blood tests for every system (kidney, liver, sugar and cholesterol), chest x-ray, ECG, EchoCardiography and treadmill test if required. If the individual falls in the high risk category for heart diseases which means if they have a family history of heart diseases, high blood pressure, diabetes, history of chronic smoking, excessive alcohol consumption or obesity and especially if the individual has symptoms of heart ailments like chest pain or discomfort and breathlessness etc, they should go for these tests even before the age of 40 and consult a cardiologist.
Dr Vivek explains, “There are a lot of controversies regarding executive checkups and routine tests to look after your heart health. People panic because every day we hear about people collapsing in the gym, while cycling etc. What is definitely recommended for everyone starting at the age of 30 years is regular BP check, weight measure, sugar and cholesterol measurements. The frequency can be decided on an individual basis depending on the underlying heart risk. Even 2-3 yearly tests for glucose and cholesterol, and yearly check of blood pressure is quite reasonable in healthy fit people. People who are at higher risk for heart disease e.g., strong family history of heart disease, people with diabetes, obesity, those recovering from serious COVID etc, should be screened more frequently and also more extensively with added tests. These may include specialized kidney and urine tests, echocardiogram, etc. In sedentary patients at high risk of heart disease a treadmill test or a coronary calcium score may also be reasonable. In very few selected cases with high disease risk and atypical heart symptoms, a CT coronary angiogram is also ordered.”
How to maintain a heart healthy lifestyle?
Having a heart healthy lifestyle has also been shown to reduce inflammation and decrease hsCRP. This includes total avoidance of active and passive exposure to smoking and tobacco; a healthy diet of mostly unprocessed food with high fiber content, maintaining ideal body weight, and regular physical activity.
Dr Ankur Phatarpekar, Director Cathlab and Interventional Cardiologist, Symbiosis Hospital, Mumbai shares, “The different preventive measures that can be taken to keep the heart healthy can be categorized as lifestyle modifications and drug-based treatments. Lifestyle modifications that can be done are eating a healthy balanced diet, exercising regularly, maintaining healthy body weight, cessation of smoking, and reducing alcohol consumption. These lifestyle modifications also contribute to lowering the blood glucose level as well as the blood pressure that affects the heart. Drug-based treatments include the treatments for CVD in addition to the treatment for high cholesterol levels, high blood pressure, and high glucose level in blood.”