Reverse Heart Disease
CRP or C-Reactive Protein. You have HIGH CRP levels? What to do when your CRP levels are HIGH.
Your CRP (C Reactive Protein) Is High?
Well, you went and did it - you had your CRP level measured, and it's high. I sincerely hope that before you did so, you'd read " Should You Have Your CRP Measured?" so that at least the dilemma you're now facing has a point to it. But either way, deciding what to do about an elevated CRP level is almost never straightforward.
The fundamental problem is that no one really knows whether the CRP itself is causing a problem, and thus ought to be reduced, or whether the CRP is merely a marker for the inflammation in atherosclerotic plaques, in which case reducing the CRP levels may lead to no direct benefit.
In any case, now that you know your CRP is high, there are three questions you should be asking.
1) What does my doctor recommend?
A rule that good doctors follow is: never order a test if you know ahead of time that you're not going to know what to do with the results.
If your doctor ordered the CRP, he/she should have a clear idea of what to recommend now that the test has come back "elevated." So talk to your doctor. If he/she cannot give you reasonable recommendations or just smiles at you sheepishly, then he/she did not follow this rule that good doctors follow. I'll leave it to you to draw your own conclusions about that.
2) What are my other risk factors?
Elevated CRP levels are almost always associated with other risk factors for heart disease. These include smoking, obesity, sedentary lifestyle, increased cholesterol, hypertension and metabolic syndrome.
One thing we know now is that, whatever you thought your cardiac risk was before the CRP was measured, now it's higher. So, whether you try to reduce the CRP itself or not, clearly you need to take aggressive measures to get rid of the other risk factors - the ones where, we already know, reducing them will reduce your risk. You can start here - What to do if your cardiac risk is high.
3) How can I reduce my CRP level?
While, as I've stated, there is no direct evidence that reducing CRP levels lowers cardiac risk, there is certainly quite a bit of circumstantial evidence that it might. So, if CRP can be reduced relatively easily and safely, why not try to bring it down? Several ways of reducing CRP have been identified. Non-pharmacological methods of reducing CRP include aerobic exercise, weight loss and diet.
In one study, healthy adults eating either a standard low saturated fat diet or the same diet plus plant sterols, soy protein, and nuts both had reductions in CRP levels. However, those on the plant sterol diet had a greater reduction.
In another study that enrolled severely obese patients, reductions in CRP were achieved with either a fat restricted or carbohydrate restricted diet; however, the low-carb diet seemed to be more effective in reducing CRP
Drug therapy can also reduce CRP. Statins reduce CRP levels significantly (13 to 50%,) according to several clinical trials. Atorvastatin, lovastatin, pravastatin, and simvastatin have all proven to bring down CRP levels. Some of these clinical trials also have provided supportive evidence (but not proof) that the reduction in CRP (as opposed to cholesterol reduction) led to a reduced risk of cardiovascular events.
While aspirin does not reduce CRP levels, patients with elevated CRP levels gain more risk-reduction benefit from aspirin than those with normal CRP levels. So elevated CRP levels may tip the scales in favor of prophylactic aspirin therapy for some. The diabetic drugs rosiglitazone and pioglitazone, used in patients with type 2 diabetes, reduce CRP levels. Finally, in one study of patients with known coronary artery disease, beta blockers were shown to reduce CRP levels by 31%.
None of these drugs are approved specifically for treating high CRP levels, and most doctors would be reluctant to use them for this sole purpose, given the current state of evidence. In most cases, aggressively treating other risk factors should be the first step. Odds are good that after doing so, the CRP level will also be reduced. In patients with elevated CRP who have few or no other risk factors, however, especially if they have a strong family history of cardiovascular disease, might want to talk to their doctors about the risks versus benefits of drug therapy for CRP reduction.
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