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Experts downplay heart test value
2003 January 27
DALLAS, Jan 27, 2003 (United Press International via COMTEX) -- A new and widely used blood test might be of only limited value in assessing heart disease risk, experts reported Monday.
In an article to be published in the Jan. 28 issue of the journal Circulation, a panel convened by the American Heart Association and the Centers for Disease Control and Prevention concluded that the C-reactive protein, or CRP, test be used only in addition to cholesterol testing and blood-pressure screening and only in specific diagnostic situations.
"In many ways, the horse is out of the barn," co-chair Dr. Thomas Pearson, senior associate dean for clinical research at the University of Rochester (N.Y.) School of Medicine, told United Press International. "The CRP test is freely available to physicians, and thousands of them are being given each week around the country. Some doctors give them to everybody. Some doctors give them to nobody. Our panel was gathered to hold this test up to rigorous diagnostic standards and to inform doctors how it might be used, to define the clinical value of the test based on what we know now."
C-reactive protein is a blood-borne signal of blood vessel inflammation, which has been associated in clinical research with an increased risk of coronary heart disease, peripheral arterial disease and sudden death.
Publicity over the past two years about the potential value of C-reactive protein testing has led to skyrocketing public demand for the test. However, the panel's report represents the first time guidelines have been issued for the clinical application of the test or evaluation of its results.
The panel recommended the test be used only in situations where a physician is undecided about treatment for a patient at intermediate heart attack risk -- someone considered to have a 10 percent to 20 percent risk for heart attack in the next 10 years based on his or her cholesterol testing and high blood pressure screening.
"In those cases, a follow-up CRP test looks like it could be truly helpful to a physician in deciding about moderate or aggressive treatment," said Pearson.
In an effort to begin to define "what the test results even mean," Pearson explained, the experts developed numerical ratings for low, average and high-risk results. Expressed in milligrams per liter, or mg/L, less than 1.0 mg/L is considered low risk, 1.0-3.0 mg/L average risk and 3.0 mg/L or higher high risk.
The panel members emphasized they do not consider the new test as diagnostically important as cholesterol testing or high blood pressure screening. For most patients, they concluded, the emphasis must remain on detection, treatment, and control of the major risk factors, such as high blood pressure, high blood cholesterol, cigarette smoking and diabetes.
"The recommendations in this report should be helpful as we work to improve our ability to identify populations at risk," Dr. Sidney Smith, professor of medicine at the University North Carolina at Chapel Hill School of Medicine and past president of the American Heart Association, told UPI.
"CRP (C-reactive protein) testing provides an important link between the traditional risk factors and the new science of inflammation," Smith said. "In order to understand the appropriate role for CRP testing we need the results from clinical trials to demonstrate that medical therapies based on CRP and traditional risk factors can reduce the risk of heart attack and stroke."
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(Reported by Bruce Sylvester, UPI Science News, in West Palm Beach, Fla.)
Copyright: Copyright 2003 by United Press International
2003 January 27
DALLAS, Jan 27, 2003 (United Press International via COMTEX) -- A new and widely used blood test might be of only limited value in assessing heart disease risk, experts reported Monday.
In an article to be published in the Jan. 28 issue of the journal Circulation, a panel convened by the American Heart Association and the Centers for Disease Control and Prevention concluded that the C-reactive protein, or CRP, test be used only in addition to cholesterol testing and blood-pressure screening and only in specific diagnostic situations.
"In many ways, the horse is out of the barn," co-chair Dr. Thomas Pearson, senior associate dean for clinical research at the University of Rochester (N.Y.) School of Medicine, told United Press International. "The CRP test is freely available to physicians, and thousands of them are being given each week around the country. Some doctors give them to everybody. Some doctors give them to nobody. Our panel was gathered to hold this test up to rigorous diagnostic standards and to inform doctors how it might be used, to define the clinical value of the test based on what we know now."
C-reactive protein is a blood-borne signal of blood vessel inflammation, which has been associated in clinical research with an increased risk of coronary heart disease, peripheral arterial disease and sudden death.
Publicity over the past two years about the potential value of C-reactive protein testing has led to skyrocketing public demand for the test. However, the panel's report represents the first time guidelines have been issued for the clinical application of the test or evaluation of its results.
The panel recommended the test be used only in situations where a physician is undecided about treatment for a patient at intermediate heart attack risk -- someone considered to have a 10 percent to 20 percent risk for heart attack in the next 10 years based on his or her cholesterol testing and high blood pressure screening.
"In those cases, a follow-up CRP test looks like it could be truly helpful to a physician in deciding about moderate or aggressive treatment," said Pearson.
In an effort to begin to define "what the test results even mean," Pearson explained, the experts developed numerical ratings for low, average and high-risk results. Expressed in milligrams per liter, or mg/L, less than 1.0 mg/L is considered low risk, 1.0-3.0 mg/L average risk and 3.0 mg/L or higher high risk.
The panel members emphasized they do not consider the new test as diagnostically important as cholesterol testing or high blood pressure screening. For most patients, they concluded, the emphasis must remain on detection, treatment, and control of the major risk factors, such as high blood pressure, high blood cholesterol, cigarette smoking and diabetes.
"The recommendations in this report should be helpful as we work to improve our ability to identify populations at risk," Dr. Sidney Smith, professor of medicine at the University North Carolina at Chapel Hill School of Medicine and past president of the American Heart Association, told UPI.
"CRP (C-reactive protein) testing provides an important link between the traditional risk factors and the new science of inflammation," Smith said. "In order to understand the appropriate role for CRP testing we need the results from clinical trials to demonstrate that medical therapies based on CRP and traditional risk factors can reduce the risk of heart attack and stroke."
--
(Reported by Bruce Sylvester, UPI Science News, in West Palm Beach, Fla.)
Copyright: Copyright 2003 by United Press International
