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(Stroke. 2005;36:1316.)
© 2005 American Heart Association, Inc.

Special Report

Evaluation of C-Reactive Protein Measurement for Assessing the Risk and Prognosis in Ischemic Stroke

A Statement for Health Care Professionals From the CRP Pooling Project Members

Mario Di Napoli, MD; Markus Schwaninger, MD; Roberto Cappelli, MD; Elena Ceccarelli, MD; Giacinto Di Gianfilippo, MD; Cristina Donati, MD; Hedley C.A. Emsley, PhD, MRCP; Sandro Forconi, MD; Stephen J. Hopkins, PhD; Luca Masotti, MD; Keith W. Muir, MD, FRCP; Anna Paciucci, MD; Francesca Papa, MD; Sabina Roncacci, MD; Dirk Sander, MD; Kerstin Sander, MD; Craig J. Smith, MD, MRCP; Alessandro Stefanini, MD Daniela Weber, MD

From the Neurological Service (M.D.N., G.D.G., A.P., S.R., A.S.), San Camillo de Lellis General Hospital, Rieti, Italy; Neurologische Klinik (M.S., DW.), University of Heidelberg, Heidelberg, Germany; the Department of Internal (R.C., E.C., C.D., S.F.), Cardiovascular, and Geriatric Medicine, University of Siena, Siena, Italy; Division of Neuroscience (H.C.A.E.), University of Liverpool, The Walton Centre for Neurology & Neurosurgery, Liverpool, UK; Injury Research (S.J.H.), University of Manchester and Hope Hospital, Salford, UK; Internal Medicine (L.M.), Cecina Hospital, Cecina, Livorno, Italy; the Division of Clinical Neurosciences (K.W.M.), University of Glasgow, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, UK; SMDN–Center for Cardiovascular Medicine and Cerebrovascular Disease Prevention (F.P.), Sulmona, L’Aquila, Italy; the Department of Neurology (D.S., K.S.), Technical University of Munich, Munich, Germany; and the Division of Medicine and Neurosciences-Hope (C.J.S.), University of Manchester, Hope Hospital, Salford, UK.

Correspondence to Mario Di Napoli, MD, Neurological Section, SMDN–Center for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Via Trento, 41, 67039-Sulmona, L’Aquila, Italy. E-mail mariodinapoli{at}katamail.com

Background and Purpose— Several studies have shown, in different populations, that modest elevation of plasma C-reactive protein (CRP) in the range seen in apparently healthy individuals is a strong predictor of future vascular events. Elevated plasma CRP concentrations are also associated with an increased risk of cerebrovascular events and an increased risk of fatal and nonfatal cardiovascular events in ischemic stroke patients. These epidemiological and clinical observations suggest that determination of plasma CRP concentrations could be used as an adjunct for risk assessment in primary and secondary prevention of cerebrovascular disease and be of prognostic value. The aim of this review is to summarize the evidence for CRP as an independent predictor of cerebrovascular events in at-risk individuals and ischemic stroke patients and to consider its usefulness in evaluating prognosis after stroke.

Summary of Review— CRP fulfils most of the requirements of a new risk and prognostic predictor, but several issues await further confirmation and clarification before this marker can be included in the routine evaluation of stroke patients and subjects at risk for cerebrovascular disease. Potentially important associations have been established between elevated plasma CRP concentrations and increased efficacy of established therapies, particularly lipid-lowering therapy with statins.

Conclusion— At present, there is not sufficient evidence to recommend measurement of CRP in the routine evaluation of cerebrovascular disease risk in primary prevention, because there is insufficient evidence as to whether early detection, or intervention based on detection, improves health outcomes, although shared risk of cardiovascular disease indicates this may be of value. In secondary prevention of stroke, elevated CRP adds to existing prognostic markers, but it remains to be established whether specific therapeutic options can be derived from this.

Key Words: aspirin • cerebrovascular disorders • inflammation • meta-analysis • mortality • prevention • risk factors • scientific statements

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