George A. Mensah, M.D., cochair of the writing group, explained, “For clinicians and public health practitioners, it is important to emphasize that although abnormal highly sensitive C-reactive protein values identify high-risk persons, we have no evidence that treatment strategies based on [protein] levels improve survival or reduce cardiovascular complications.

“Although our statement identifies a subgroup of patients who may benefit from [protein] testing, for most patients 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,” added Mensah.

The writing group does not consider the new test in the same category as cholesterol testing or blood pressure screening. However, Pearson said the test might be useful when a physician is undecided about a course of treatment for a patient who is considered intermediate risk. For example, a person at intermediate risk may be someone considered to have a 10 to 20 percent risk for myocardial infarction in the next 10 years based on current health status and history. “In those cases, a highly sensitive C-reactive protein test might tip the scale to help a physician decide on moderate or more intensive treatment,” he said.

Pearson explained that the writing group wanted to address the concerns of physicians whose patients are requesting protein testing, even though there has been very little clinical evidence to support widespread testing. The joint panel reports that the results of tests should be expressed as milligrams per Liter (mg/L) with concentrations of less than 1.0 mg/L defined as low risk, 1.0-3.0 mg/L as average risk, and concentrations higher than 3.0 mg/L defined as high risk. People in the high-risk group have about a 2-fold increase in relative risk for cardiovascular disease compared with people in the low-risk group.

Pearson said the new recommendations are based on currently available evidence and may change as new trial data become available. At the present time, the panel states that protein level can be an independent marker of risk and may be useful as a tool for evaluating people with moderate risk. However, there is insufficient evidence to use protein level to track the efficacy of treatment.