Many years ago the Federal government initiated a program called the conservation reserve program or (for short) CRP.  This has been wonderful for pheasant hunters and for farmers who wanted to give their land a rest but this CRP isn’t what we are talking about in this column.

     Medically, CRP stands for “cold reactive protein”.  It is a protein that is made by the liver when the body encounters an infection or an injury.  We are not sure what it does but measurement of the amount of this material in the blood provides a good index of how well an inflammatory condition or an injury is healing.

     As an example, a lady came into the hospital last week with a severe pneumonia.  TheCRP rose to 32 mg%.  Normally he value is .5 mg% or less so she had a very substantial infection.  She was treated with antibiotics and procedures to help her clear secretions.  This  resulted in resolution of her fever, cough, and chest pains as the CRP dropped down to .5 mg% by the 6th hospital day.  The test was followed daily and would drop 3-5 mg % each day.  Thus, this test provides a good index of how well a pneumonia might be treated.

     Over the past many years, it has been theorized that heart attacks are not just a problem of high cholesterol, high blood pressure, smoking, and diabetes.  Many people who have  heart attacks do not have severe elevations in blood pressure or cholesterol and not everyone that has high blood pressure and cholesterol has heart attacks.  It has been thought that there must be some other factor that triggers the heart attack.

    Studies have been done to examine the site on an artery that was blocked thereby causing a heart attack.  It was noted that there was often inflammation at the site where the artery was blocked.  This lead to the idea that chronic irritation and inflammation at a site on a blood vessel causes a scar to develop.  The scar gets bigger and bigger and eventually shuts the artery off causing the heart attack.  What causes the inflammation is still not known.

     With the finding that there was inflammation in the blood vessels of people who had heart attacks, research was begun to measure the CRP in otherwise healthy people to see if this would be a marker warning that heart attacks were coming in people with high CRP’s.  The  studies have now been done and redone and there is no longer any argument.  A high CRP value on a chronic basis in an otherwise healthy individual is definitely a marker putting that person in a high risk group for development of heart attack.  This becomes one more blood test like the cholesterol and the blood sugar that can be used as a warning sign that a heart attack might be coming.

     There is now a campaign being developed to have CRP values measured in otherwise  healthy individuals to detect those at risk for the unexpected and sudden heart attack.  The tests  are available through your local clinics at modest cost.

 Other uses of this test include monitoring the effectiveness of treatment steps that are taken to prevent the heart attack.   As an example, the “statin” family of anti-cholesterol drugs were developed to help lower the serum cholesterol and thereby stop heart attacks. Mysteriously, this same statin family of drugs stops heart attacks in people that don’t have high cholesterols.  That was unexpected.  Why in the world would a cholesterol lowering drug given to somebody whose cholesterol is already low prevent heart attack?  The answer seems to reside in the CRP test.  When a statin drug is given, it appears to have an anti-inflammatory affect in  addition to its cholesterol lowering affect.  Ah!  How nice it is to have fringe benefits instead of side effects.  So now if a person is found to have a slightly high CRP even if their cholesterol is normal, the use of a statin drug is advised as a preventive for heart attack.

     For years, doctors have advocated the use of an aspirin per day to prevent blood clots that might cause heart attacks.  The theory behind this sounds quite logical.  By the way, one of the fringe benefits of taking aspirin is that it lowers the CRP.   Maybe the real affect of aspirin isn’t clot prevention but instead a decreased inflammation thereby preventing the heart attack.

     The bottom line, as always, comes back to the broken record saying again, and again, and again, that prevention and life style modification are the two most important steps in preventing heart attacks.  Smoking cigarettes is a guaranteed way to increase the blood CRP.  Chronic fatigue and over work is another factor that can raise CRP.  Following mother’s rules works really good for little kids even when they grow up and become adults.  Get enough sleep.  Don’t stay in the sun too long.  Protect yourself from the cold.  Protect yourself from the hot.  Don’t get chilled .  Don’t eat too many candy bars.  Don’t drink too much coffee.  Don’t drink too much beer, etc. etc. etc. etc.  Although they sound like harping, mother’s rules really do work.

     Your local clinic has the blood test available to measure CRP.  The ideal person that needs this test is the otherwise healthy robust 45 year old gentleman who knows that there is not a thing wrong with him.  A blood cholesterol, a CRP, and blood pressure check are important for this gentleman.  They are all silent, sneaky markers for the unexpected heart attack.  For those individuals who already know they have a heart problem, the CRP can be used as an index of successful treatment;  the lower the CRP goes, the better the treatment is working.