C-Reactive Protein and Cardiovascular Risk in the General Population

This large contemporary prospective cohort study examined hsCRP as a predictor of cardiovascular events in primary prevention — asking whether inflammation adds meaningful predictive information beyond standard risk models and, if so, how much.

In the general population, hsCRP ranked above LDL cholesterol in predictive strength for cardiovascular events. Adding hsCRP to the SCORE2 risk model produced a net reclassification improvement of 14 percent — a substantial incremental gain for a single, widely available test. Predictive value was stable with a single measurement, consistent across subgroups, and present even in patients without traditional cardiovascular risk factors.

The clinical and guideline implications are significant. Coupled with CANTOS (which showed reducing CRP with canakinumab reduces events) and JUPITER (rosuvastatin reducing events specifically in elevated-CRP patients), this study adds contemporary cohort evidence that inflammation measured by hsCRP captures risk that lipid-centric models miss. The case for routine hsCRP testing in primary prevention risk stratification — already endorsed by many guidelines — is further strengthened.

We rate the evidence strong. A large, well-conducted prospective cohort demonstrating that hsCRP provides meaningful, additive cardiovascular risk information beyond standard lipid-based models in primary prevention.