BEWARE! CRP test is NOT hs-CRP test
Type 2 diabetes is an inflammatory atherothrombotic condition associated with a high prevalence of cardiovascular disease. In patients with type 2 diabetes, low grade inflammation is reflected by increased plasma levels of several biomarkers of inflammation such as C-reactive protein (CRP).
C- Reactive Protein is a marker of chronic inflammation and is an independent predictor of all cause cardiovascular mortality.
In cross-sectional studies, highly sensitive – CRP has been found to correlate with increased triglyceride, decreased HDL, increased blood pressure and increased fasting plasma glucose concentrations, suggesting its association with increased prevalence metabolic syndrome associated with insulin resistance and signals an increased risk for practically all degenerative disorders, including cardiovascular disease, cancer, nephropathy progression, diabetes and more.
In a cross-sectional study involving 125 MetS patients recruited at Department of Biochemistry of B P Koirala Institute of Health Sciences, Nepal, rise of hs-CRP, uric acid, or both tends to associated with increased risk for hypertension, hyperglycemia and low HDL cholesterol. Similarly, combined rise of hs-CRP and uric acid is associated with the increase in severity of MetS. Thus, hs-CRP and uric acid may be used to assess severity of MetS.
One study in Pokhara, Nepal concludes that the increase in serum hs-CRP value in type 2 diabetic patients increase the risk of diabetic nephropathy and thus increase the value of serum creatinine level. And there is no correlation of both serum hs-CRP and creatinine level with the risk factors especially sex and family history of type 2 diabetes. The significance of these findings emphasizes to choose these associations for early screening and staging of diabetic nephropathy.
Therefore, we ask our patients to get their C-Reactive Protein (CRP) levels checked during the course of their diabetes reversal program.
Values greater than 3.0 mg/L suggest an increased likelihood of developing cardiovascular disease or ischemic events.
The risk of developing cardiovascular disease is quantified as follows :
- Low risk: hs-CRP level under 1.0 mg/L
- Average risk: between 1.0 and 3.0 mg/L
- High risk: above 3.0 mg/L
- Very high risk: 5-10 mg/L
- Above 10 mg/L – clinically significant inflammatory states
It’s important to order the High-sensitivity CRP or hs-CRP test.
The standard CRP test is ordered for people with symptoms of serious bacterial infection or chronic inflammatory disease. It measures CRP in the range from 10 to 1000 mg/L, while hs-CRP test measures CRP in the range from 0.3 to 10 mg/L.
The “routine” CRP reference range is 0.0-0.7 mg/dL (mg/DECILITER). If a “routine” CRP has been used as an inflammatory marker and a hs-CRP is performed, the results can in most cases be compared by simply dividing the hs-CRP value by 10 as this converts the value from mg/L to mg/dL.
CRP can be elevated in pregnancy (median value of 4.8 mg/L, interquartile range of 0.63 – 15.7 mg/L), and these elevations are evident from even the earliest gestational ages and can persist throughout gestation. Fluctuations are common (R).
Viral infections and any mild inflammation elicit a smaller increase in CRP level (10–40 mg/L), while bacterial infection, as well as active inflammation, can elicit much higher responses of between 40–200 mg/L. In some severe bacterial infections and burns, the level can increase more than 200 mg/L (R).
CRP peaks at about 15:00 hours each day, with a 1% variation in CRP level attributed to the daily and seasonal effects. Very small changes occur during the menstrual cycle in females (R).
A lack of CRP elevation in inflammation may be seen with liver failure, as well as during flares of conditions such as systemic lupus erythematosus (R).
Elevations of CRP in the absence of clinically significant inflammation can occur in renal failure (R).
CRP is positively correlated with BMI, waist circumference, blood pressure, triglycerides, cholesterol, LDL cholesterol, blood glucose, and fasting insulin, and it was inversely correlated with HDL cholesterol and insulin sensitivity (R).
Strong associations are observed between CRP levels, central obesity, and insulin resistance (R).
Additionally, CRP in the setting of MetS confers an increased risk of future cardiovascular events (R).