I wish to open this discussion to get feedback from all those clinicians and researchers out there struggling to find out which one is a better predictor of overall risk of cardiovascular events. Many of us and in fact most of us have been focussed on the cholesterol levels to determine the risk until a recently published study (JUPITER Study) in New England Journal of Medicine reported that C Reactive Protein (CRP) may be a better predictor and an independent marker of cardiovascular risk as opposed to just LDL cholesterol. The study showed that patients with high LDL cholesterol and high CRP levels were at higher risk than those with high LDL cholesterol but low CRP levels. It was also observed that patients with normal LDL cholesterol with high CRP levels are at higher risk than those with normal LDL cholesterol and low or normal CRP levels. In these patients, measuring only the LDL cholesterol may not be very helpful or in other words, these patients may not be identified as those at risk and may end up developing a coronary artery disease.
We know that CRP is released in response to any inflammation in the body. Several studies have shown a connection between inflammation and atherosclerosis, which is basically attested by the JUPITER study.
Does that mean that we should start measuring CRP levels regularly to screen or monitor patients at high risk? Is it still important to measure LDL cholesterol? Do we really need to know the triglyceride levels? Should we still look at other risk markers now that we have CRP as an emerging independent marker?
I personally feel that body does not work in isolation and relying upon just one or two risk factors may not be a smart decision. It is extremely important to consider the overall balance of major physiological functions within the body to get a comprehensive picture of overall risk.