Should You Be Tested?

By MICHAEL D. LEMONICK

About a??year??ago, my doctor put me on the statin drug Lipitor. My LDL--the bad cholesterol--was a bit high, and diet and exercise hadn't reduced it very much. The drug worked. At my last checkup, about a month ago, my LDL had plunged.

As for my levels of c-reactive protein, or CRP--who knows? My doctor didn't test for it, and it didn't occur to me to ask. But two reports in last week's New England Journal of Medicine suggest that CRP may be just as important a risk factor for coronary-artery disease and heart attacks as LDL--and maybe more so. Does that mean I should have had the test? Not on the basis of what was known then. But now things are different.

CRP is a protein secreted by the liver in response to inflammation, and over the past several years it has become apparent to experts that inflammation is a big part of heart disease. CRP seems to play a role in damaging artery walls, making them more prone to the buildup of fatty plaques that can rupture and block the vessels that feed the heart. Sure enough, studies have shown that high CRP levels, signaling active inflammation, are associated with heart problems.

Doctors also know that statins can reduce inflammation. So cardiologists from Brigham and Women's Hospital in Boston put 3,745 patients who had experienced heart attacks or severe chest pain on statins, and later measured levels of both LDL and CRP. It turned out that patients who ended up with low CRP were less likely to have heart attacks or die than those whose CRP stayed high--whether or not their LDL levels went down. Showing that CRP reduction is at least as important as cholesterol reduction, says Dr. Paul Ridker, lead author of the report, is a "home run."

The second study, from the Cleveland Clinic, also tracked cardiac patients, but instead of looking at heart attacks, the researchers measured actual plaque buildup. The patients whose CRP dropped the most on statins saw their plaques get smaller--again, independent of what happened to their LDL.

That doesn't mean my doctor was remiss in not testing me. The patients in the studies were all suffering from cardiovascular disease. I'm not. And until the CRP story is understood more fully, the side effects of statins--which can include liver and muscle damage--could outweigh their clear benefits. But if CRP is as important as it appears, it probably makes sense for anyone who's at risk for heart disease to be evaluated. It's a simple blood test that any lab can do, and while it might not be covered by all insurance, it costs $15 at most. That's a price I'm willing to pay. --With reporting by Alice Park/New York

With reporting by Alice Park/New York