Inflammation and Biomarkers: Redefining Cardiovascular Risk

The American College of Cardiology now endorses screening for C-reactive protein (CRP), elevating inflammatory burden alongside traditional lipid measures in cardiovascular risk assessment. The ACA cited pooled-cohort analyses suggesting that C-reactive protein (CRP) may outperform LDL cholesterol for population-level prediction of myocardial infarction and stroke.

High-sensitivity CRP (hs-CRP) testing can refine risk estimates alongside lipid panels in selected patients: adults at intermediate predicted risk, people with unexplained residual risk despite optimal LDL, and patients with borderline estimated statin benefit. The hs-CRP assay detects low-grade systemic inflammation and functions as an adjunctive discriminator that complements rather than replaces lipid profiling.

Lifestyle interventions—Mediterranean-style diets, increased fiber, reduced refined carbohydrates, smoking cessation, weight loss, and regular aerobic exercise—are associated with modest reductions in CRP. Effect sizes are typically small to moderate and depend on baseline risk and intervention intensity; nonetheless, behavior change can lower inflammatory burden and, by extension, biomarker-derived risk.

Therapeutic development increasingly targets inflammation, with biomarker-guided prevention strategies progressing from proof-of-concept to early clinical testing. Approaches under investigation include selective anti-inflammatory agents, repurposed immunomodulatory drugs, and precision strategies that enroll patients with elevated CRP. Current evidence is concentrated in early-phase trials or studies using surrogate endpoints; CRP-guided patient selection is poised to inform trial design and prioritize therapies for those with persistent inflammatory risk despite optimal lipid control.

Key Takeaways:

• What’s new? A news summary reported that the American College of Cardiology endorses CRP screening and suggested CRP may have greater population-level predictive value than LDL for myocardial infarction and stroke.
• Who’s affected? Adults at intermediate predicted risk, patients with unexplained residual risk despite controlled LDL, and those with borderline estimated statin benefit are most impacted.
• What changes next? Consider integrating hs-CRP into risk-stratification workflows, resolve testing logistics and assay standardization, and prioritize outcome-driven trials to assess biomarker-guided interventions.