New Guideline For Heart Attack Risk

[selmaborntidefan]

Ok, this hasn’t gotten a lot of play - for the record, these tests are run in my section of the lab I manage, and I had not even heard of this until just now - but this could be a game changer:

C-reactive protein outranks ‘bad’ cholesterol as leading heart disease risk marker

(The Conversation) – Heart disease is the leading cause of death in the United States. Since researchers first established the link between diet, cholesterol and heart disease in th…

www.wcia.com

Heart disease is the leading cause of death in the United States.

Since researchers first established the link between diet, cholesterol and heart disease in the 1950s, risk for heart disease has been partly assessed based on a patient’s cholesterol levels, which can be routinely measured via blood work at the doctor’s office.


However, accumulating evidence over the past two decades demonstrates that a biomarker called C-reactive protein – which signals the presence of low-grade inflammation – is a better predictor of risk for heart disease than cholesterol.

As a result, in September 2025, the American College of Cardiology published new recommendations for universal screening of C-reactive protein levels in all patients, alongside measuring cholesterol levels.

What is C-reactive protein?

C-reactive protein is created by the liver in response to infections, tissue damage, chronic inflammatory states from conditions like autoimmune diseases, and metabolic disturbances like obesity and diabetes. Essentially, it is a marker of inflammation – meaning immune system activation – in the body.

C-reactive protein can be easily measured with blood work at the doctor’s office. A low C-reactive protein level – under 1 milligram per deciliter – signifies minimal inflammation in the body, which is protective against heart disease. An elevated C-reactive protein level of greater than 3 milligrams per deciliter, signifies increased levels of inflammation and thus increased risk for heart disease. About 52% of Americans have an elevated level of C-reactive protein in their blood.

Research shows that C-reactive protein is a better predictive marker for heart attacks and strokes than “bad,” or LDL cholesterol, short for low-density lipoprotein, as well as another commonly measured genetically inherited biomarker called lipoprotein(a). One study found that C-reactive protein can predict heart disease just as well as blood pressure can.


(it’s late, and I’m on my phone, but I will be back to explain some stuff from the pandemic on this tomorrow. This could be big).

 

[Toddrn]

Ok, this hasn’t gotten a lot of play - for the record, these tests are run in my section of the lab I manage, and I had not even heard of this until just now - but this could be a game changer:

C-reactive protein outranks ‘bad’ cholesterol as leading heart disease risk marker

(The Conversation) – Heart disease is the leading cause of death in the United States. Since researchers first established the link between diet, cholesterol and heart disease in th…

www.wcia.com

Heart disease is the leading cause of death in the United States.

Since researchers first established the link between diet, cholesterol and heart disease in the 1950s, risk for heart disease has been partly assessed based on a patient’s cholesterol levels, which can be routinely measured via blood work at the doctor’s office.


However, accumulating evidence over the past two decades demonstrates that a biomarker called C-reactive protein – which signals the presence of low-grade inflammation – is a better predictor of risk for heart disease than cholesterol.

As a result, in September 2025, the American College of Cardiology published new recommendations for universal screening of C-reactive protein levels in all patients, alongside measuring cholesterol levels.

What is C-reactive protein?

C-reactive protein is created by the liver in response to infections, tissue damage, chronic inflammatory states from conditions like autoimmune diseases, and metabolic disturbances like obesity and diabetes. Essentially, it is a marker of inflammation – meaning immune system activation – in the body.

C-reactive protein can be easily measured with blood work at the doctor’s office. A low C-reactive protein level – under 1 milligram per deciliter – signifies minimal inflammation in the body, which is protective against heart disease. An elevated C-reactive protein level of greater than 3 milligrams per deciliter, signifies increased levels of inflammation and thus increased risk for heart disease. About 52% of Americans have an elevated level of C-reactive protein in their blood.

Research shows that C-reactive protein is a better predictive marker for heart attacks and strokes than “bad,” or LDL cholesterol, short for low-density lipoprotein, as well as another commonly measured genetically inherited biomarker called lipoprotein(a). One study found that C-reactive protein can predict heart disease just as well as blood pressure can.


(it’s late, and I’m on my phone, but I will be back to explain some stuff from the pandemic on this tomorrow. This could be big).

So my question is, will they add this to a lipid panel so it is automatically run? I don't see my Cardiologist until May. But I will ask if he has started ordering this as a routine screening with lipids.

 

[selmaborntidefan]

So a bit of narrative to bring us up to now. To those of you in medicine, I will get some things "wrong" by virtue of trying to make it simple enough for everyone, but my intent is to give the forest not the trees.

In March 2020, as we all know, the world shut down for the pandemic. Even hospitals sort of shut down in the sense that this was early in the "15 days to stem the curve" policy. In the interim, the supply chain collapsed, which didn't matter at first because I always maintained a measured reservoir of PLENTY of supplies that would not get tossed - plus there are 17 other affiliated hospitals with mine in the DFW Metroplex.

So around mid-May or so, we went back to full service in the hospital and were deluged with patients. One of my jobs daily is to check the patient results for accuracy and doctor notification, and just by chance I noticed a sudden amazing uptick in the number of four tests ordered: Troponin (generally used to diagnose heart attacks), Lactic Acid (to diagnose sepsis), ferritin (a protein that stores iron in your body, whether low or high), and CRP, a test that basically tells you the degree of inflammation the body is exhibiting. Indeed, we began running so many of some of those tests that I went and looked on my inventory shelf and we were crucially low on ferritin and CRP. If it continued, we were going to run out and then good luck finding any in this timeframe.

But what nobody ever sent me was an email or had a briefing or took me aside - which they should have as I was the supervisor of Chemistry - to tell me to stock up because we were running extra tests on patients. I had enough lactic acids (total accident caused by Abbott Diagnostics getting sued, so we abandoned their test methodology on January 23, 2020) and troponins because we were supposed to be installing the new "high sensitivity troponin" that summer (it was delayed until October 2021).

Nobody ever explained to any of us in the laboratory why this was happening.

And we didn't have time to go asking, either.

As I noted above, the lactic acid and Troponin testing made sense. Covid patients were easily susceptible to things like sepsis and heart attacks (as well as strokes, and we were running D-Dimer tests to catch the latter in another section of the laboratory). But ferritin and CRP were puzzling.

 

[selmaborntidefan]

I later learned that ferritin testing was learned early in the pandemic as a great PREDICTOR of where the patient was and how dangerous their inflammation was going forward. When the body's immune response began, Covid would overwhelm it in some cases (hence the concerns about comorbidities) and induce such an overwhelming immune response that a release of a large amount of inflammatory proteins (called cytokines) would in turn cause the ferritin levels to rise, indicating a surge - and a patient in need of far more intensive care NOW and not later.

Working together with ferritin was the CRP, C-reactive protein.

Whereas ferritin is a protein indicative of iron storage (or deficiency), CRP is a protein produced by the liver that rises concurrent with body inflammation. It increases after macrophages (a white blood cell that surrounds pathogens (e.g. bad stuff) and T lymphocytes begin immune response and release a substance called IL-6, which is (look above) a cytokine (among many functions).

Simplistically: the illness enters your body, it activates macrophages and T cells in response, these cells release IL-6 - think of this in football terms as the blitz, where the macs and T cells are the D line and the IL-6 is the onrushing linebackers. The CRP might be seen as a running back who FIRST picks up the blitz (e.g. responds to the IL-6) and THEN after containing the IL-6 (if possible), steps forward to block (via an irreversible holding penalty) on the dead cells already contained by the macs and T-cells. This causes yet another reaction (requiring another lab if the doc wants it), but the ULTIMATE OUTCOME is body inflammation.

Testing the CRP measures the body inflammation. Think of this in terms of Matt Austin throwing a flag on a facemask and the amount of damage is either 5 or 15 yards DEPENDING on the level of infraction, er, infection.

So now step forward five years, and it all makes sense. There's a more sensitive test called "high sensitivity-CRP", which is even better. In essence, this test works along with the cholesterol levels we've used since the 1950s to give us our best guess at your odds of a heart attack. Note that this was always sort of suspected but NOW - and I hate to say it but in part due to the pandemic - we suddenly learn more about these things, things that will change medicine for the good long-term.