This is a contribution from a member of THINCS, 
The International Network of Cholesterol Skeptics


Letter to Wall Street Journal sent by Paul Rosch commenting an article by Tara Parker-Pope. The letter was not published. Parker-Pope's article is included below.

August 6,  2003  

Letters To The Editor 
The Wall Street Journal
200 Liberty Street
New York, NY 10281
Fax: 212 416-2255

CRP, LDL And Association Never Proves Causation

 Re: "A Number That Can Change Your Life" (August 5) it is important to reemphasize that an elevated CRP is merely a marker for coronary heart disease, as are countless other things like a deep earlobe crease, premature vertex baldness and elevated cholesterol or LDL.  Lowering CRP per se will not reduce heart attacks any more than would cosmetic earlobe surgery or a hair transplant.  Association never proves causation and the same applies to cholesterol and LDL.  As indicated, studies show that CRP is a more accurate predictor of coronary events than LDL and there is abundant evidence that the cardioprotective benefits of statins are related to their anti-inflammatory activities rather than any lipid lowering effects. 

 Therefore, current guidelines for statin therapy that mandate lowering LDL to an arbitrary level are inappropriate and dangerous.   Studies show that this goal is difficult if not impossible for most high-risk patients to attain, which will only lead to higher doses and more complications.  All statins have been shown to be carcinogenic in animals in doses equivalent to those currently being prescribed. Although the lag time between exposure to a carcinogen and clinical detection is often a decade or more, a disturbing twelve-fold increase in breast cancer has already been reported in one study and more skin malignancies were noted in another.  Like aspirin, the optimal dose of statins to reduce inflammation may be much lower than for other indications and perhaps monitoring CRP would be a more accurate and safer method of determining this.  

Paul J. Rosch, M.D., F.A.C.P.
Clinical Professor of Medicine and Psychiatry

New York Medical College

A Number That Can Change Your Life

This Simple Heart Test Leads to Better Habits


Good health often gets down to numbers like your weight, your blood pressure and your cholesterol. Now it's time to add a new number to the list -- your CRP. It stands for C-reactive protein, and it's a blood test that detects coronary-artery inflammation and could signal increased risk for heart attack.


Guidelines issued in January by the American Heart Association say the test is necessary only for patients who already show some heightened risk for heart disease. But many patients -- and their doctors -- are asking for the test anyway.


There's little incentive not to. The test is cheap and easy -- costing about $20. The test results come back as a single number -- a score of three or higher puts you at high risk, while a score below one is ideal. The sheer simplicity of the score makes your CRP score far less confusing than the myriad cholesterol numbers and ratios and blood-pressure fractions you're usually subjected to. That's one reason CRP is proving to be such a powerful tool in motivating patients to make dramatic and important lifestyle changes.

Doctors say patients who seemed unconcerned about their heart health are suddenly motivated to exercise, diet and quit smoking when presented with their CRP score.

"Everyone who practices preventive medicine has seen this," says Harvard professor Paul Ridker, director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital in Boston. "Physicians respond to numbers, and patients respond to numbers."


One of those patients is Kurt Fretthold, a 51-year-old administrator for a Cleveland-area university. Mr. Fretthold knew a family history of heart problems put him at risk, and he took cholesterol-lowering drugs and blood-pressure medicine. Though he was still overweight, he felt good that his total cholesterol was 193. Then a visit with doctors at the Cleveland Clinic prompted a look at his CRP. When it came back at 3.9, it was a wake-up call.


He began limiting calories to 2,000 to 2,500 a day and taking regular walks on the treadmill or outside, using fire hydrants and telephone poles to gauge his progress. Since November, he has dropped 65 pounds, and his CRP has dropped below one.


"I knew I wasn't feeling as comfortable as I should -- sometimes it just takes something to trip it," Mr. Fretthold says. "I read something about [CRP], and it scared me a little bit."

Doctors say they have been pleasantly surprised by the impact of the CRP score, which measures a protein produced by the body when blood-vessel walls are inflamed. Right now, the only proven way to lower your CRP is by diet and exercise.


"If they are overweight and their diet is poor and exercise is suboptimal, there is no better way to get them on track than using this test," says Eric Topol, chairman of cardiovascular medicine at the Cleveland Clinic. Cholesterol-drug therapy "fixes LDL [bad cholesterol] and you can cover up the lifestyle issue," Dr. Topol says. "But CRP is like the truth serum for that."


The medical community hasn't endorsed widespread use of the test in part because it doesn't want it to replace more traditional measures like cholesterol and blood pressure. The official guidelines say it should be used only on those with some other risk factors for heart disease. But many doctors like testing CRP anyway because it's cheap, and it's a way to better help people who have normal cholesterol gauge their heart-attack risk. It's well known that half the people who have heart attacks have normal cholesterol levels.

Indeed, a Harvard study that measured CRP levels in 28,000 healthy women found the CRP may be a better way of gauging heart-attack risk than LDL -- the bad cholesterol that for years has been the barometer for heart risk. In the eight-year Harvard study, women with the highest CRP levels (of 4 mg/L) were twice as likely as those with high LDL (154 mg/dL) to have had a heart procedure, heart attack or stroke, or to have died from heart disease.


Women with a high CRP but a low bad cholesterol score were at higher risk than those women with high cholesterol and a low CRP. What is so troubling is the current methods most doctors use to assess heart risk would miss the women in the study at highest risk.

One problem with CRP is there is still much that isn't known about it. It isn't clear if lowering CRP makes a difference in heart-attack risk or if it's the other changes -- lower cholesterol, weight loss, lower blood pressure and exercise -- that make the difference.

And the Harvard Heart Letter notes that unlike high blood pressure, a high CRP isn't a disease -- it is a symptom, like a fever, that simply signals something is wrong.

Harvard is in the midst of another major study that will try to determine if cholesterol-lowering drugs known as statins can have a meaningful impact on CRP in patients who have normal cholesterol. But right now, having a high CRP isn't reason enough to start drug therapy or even undergo significant medical testing. The only real solution for a high CRP is to make lifestyle changes.


"Doctors shouldn't order a stress test or an angiogram, but they should tell the patient they've got to stop smoking, go to the gym, diet and exercise, because their risk is higher," Dr. Ridker says. "If you know your CRP, you've got very important additional information."


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Updated August 5, 2003


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