Recommendations for the Use of High-Sensitivity C-Reactive Protein (Cardio CRP®) Testing

The American Heart Association (AHA) and the Centers for Disease Control and Prevention (CDC) have published recommendations for the use of high-sensitivity C-reactive protein (Cardio CRP) testing. The guidelines, published in the January 28, 2003 issue of Circulation (2003:107:499-511), can help healthcare providers to more accurately assess a patient's risk of cardiovascular disease that includes both lipid and inflammatory markers.

•	The optimal recommended use of Cardio CRP testing is to "detect enhanced absolute risk in persons in whom multiple risk factor scoring (based on the Framingham Heart Study global risk scoring system) projects a 10-year CHD risk in the range of 10% to 20%. It is estimated that this category represents an estimated 40% of U.S. adults. The guidelines do not recommend Cardio CRP testing for the entire adult population.
•	Three categories have been defined for cardiovascular disease risk assessment: Cardio CRP value (mg/L) CHD Risk Level according to AHA/CDC Guidelines <1.0 Lower relative cardiovascular risk 1.0 - 3.0 Average relative cardiovascular risk 3.1 - 10.0 Higher relative cardiovascular risk. Consider retesting in 1 to 2 weeks to exclude a benign transient elevation in the baseline CRP value secondary to infection or inflammation. >10.0 (up to 10)* Persistent elevation, upon retesting, may be associated with infection and inflammation
•	A Cardio CRP level of >3 (up to 10) mg/L may allow for "intensification of medical therapy to further reduce risk and to motivate some patients to improve their lifestyle or comply with medications prescribed to reduce their risk."
•	In patients with stable coronary disease or acute coronary syndrome (ACS), Cardio CRP "may be useful as an independent marker for assessing likelihood of recurrent events, including death, myocardial infarction, or restenosis after percutaneous coronary intervention (PCI)."
•	Metabolically stable patients should be tested twice for Cardio CRP, in the fasting or non-fasting state, with the results averaged.
•	Cardio CRP was selected as the only inflammatory marker with sufficient clinical data at this time to warrant expanded use in certain subsets of the adult population.

Note: National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines remain unchanged for the diagnosis and management of elevated cholesterol.

Quest Diagnostics reports results of Cardio CRP consistent with the AHA/CDC guidelines.

To Order Cardio CRP

•	Test Code 10124 or 10124F based on your Quest Diagnostics laboratory location (please consult with your local Quest Diagnostics Client Services Representative or your Sales Representative for additional information).
•	Test Code 10124N for Nichols Direct customers only.

Specimen Requirements

•	1 mL room temperature serum (0.5 mL minimum); refrigerated or frozen serum also acceptable. Alternatively, heparin or EDTA plasma may be submitted.
•	Overnight fasting prior to specimen collection is preferred to avoid excess turbidity due to lipemia. Samples should be collected 2 or more weeks after resolution of any acute inflammatory disease.

Life of Sample Stability Data

•	Room: 2 days
•	Refrigerated: 1 week
•	Frozen: 3 months

Online Test Information for Your Patients
Your patients can learn about health conditions and laboratory tests in our online Patient Health Library. The library is founded on evidence-based information, and includes topics such as:

•	Cardio CRP (C-Reactive Protein)
•	Cholesterol and Triglycerides Tests
•	Ask-the-Doctor Checklist
•	Work in Partnership with Your Doctor
•	Share in Every Medical Decision
•	Healthwise Self-Care Checklist
•	Making Wise Health Decisions

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