12

votes

Does high C-Reactive Protein (CRP) correlate with Coronary Artery Calcium plaque?

Answered on August 19, 2014
Created August 19, 2011 at 9:03 PM

"Might-o'chondri-AL", a prominent commenter [on seemingly every blog in existence] made some interesting comments about CRP under the latest article from Dr Davis about cholesterol.

Dr Davis' article (not super relevant to my question here)

First of all, let's get one thing straight right off the bat.

This is Might-o'chondri-AL. He is 117 years old.

alt text

And this is where he lives (actual location top secret)

alt text

This is really the only way I can picture it and justify in my brain how a guy can

A) know so much about all kinds of ridiculous things

B) have the time to read through all the articles that he keeps up with

C) take the time to comment on everything with some of the most complicated and intricate data I've ever seen.

Honestly his comments contain so much scientific data that I don't know if he is completely full of it or like the smartest dude alive. Regardless of which is true, he is definitely a mad scientist living in the mountains with a giant underground library below his house. I will not be convinced otherwise so please don't even try.

Okay so now that we got that out of the way... Here is what he said about CRP...

CRP (C-reactive protein), an inflammation marker surrogate, does not directly correlate with whether there is coronary artery calcium (CAC), or the degree of CAC severity. CRP is also subject to variables of race and age, so it loses some potential as a predictive marker. Yet looking at CAC along with CRP is considered useful for complex insight into a patients pathology.

Analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) involving 6,800 men & women seems to indicate that inflammatory markers (ex: CRP) relate to the physiology of pathological processes other than CAC laid down; possibly because plaque undergoes morphological changes over time. The CRP level is proposed, by some, to relate more to the stability of plaque from rupturing and the incidence of blood clotting in a thrombosis.

The inflammatory marker of Interleukin-6 (IL-6) anti-bodies seems to be better than CRP and fibrinogen for correlating an individual???s trend toward CAC. Thus the cytokine IL-6 is a better indicator of sub-clinical atherosclerosis; Doc likes to cut to the chase, eyeball the plaque and track it with current technology ( that is not available worldwide).

It has been my understanding that CRP is a very reliable marker for inflammation (exactly as his opening states) but if it cannot be correlated with CAC, does this mean that seeing a really low CRP on your labs doesn't necessarily mean you are less likely to have a CAC (and therefore atherosclerosis)?

Can we hack this please?

Af1d286f0fd5c3949f59b4edf4d892f5

(18472)

on October 24, 2011
at 05:38 PM

my story of Mighty Al is way more fun than the truth.

77877f762c40637911396daa19b53094

(78457)

on October 24, 2011
at 09:04 AM

I loled at pics :)

77877f762c40637911396daa19b53094

(78457)

on October 24, 2011
at 09:02 AM

Not a fetish, just curiosity. I collect bunch of things, M-Al epic posts is just one of them.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 24, 2011
at 05:39 AM

You seem to have a fetish on Mighty Al. I'm gonna have to warn him about finding a rabbit boiling in his kitchen.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 24, 2011
at 05:00 AM

Well, here's one exception. If you're in the middle of an autoimmune attack (let's say RA), you could have very high CRP. How would you interpret that? Unless you tested for some autoimmune marker, you wouldn't know. But it would be one clue to continue the sleuthwork. ESR isn't as sensitive as CRP. That said, most internists and cardiologists don't bother with CRP, as they follow the Framingham checklist to measure other risk factors: for them ... the risk factors are smoking, BP, age, other medications, IR, etc. Inflammation is embedded in them, so they construe that to be overlapping.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 24, 2011
at 04:46 AM

The link shows Mighty Al at 60, not 117.

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on October 23, 2011
at 07:15 PM

Namby HS crp is better but it still is only a start. Sadly if insurance did not dictate what we can order other labs would be ordered. That is not how things can be done.

77877f762c40637911396daa19b53094

(78457)

on October 23, 2011
at 05:59 PM

Yes, I collected some of them :)

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on October 23, 2011
at 04:26 PM

http://www.trackyourplaque.com/blog/ JKronk you need to read this blog. This flies in the face of what some people think are safe starches or carbs. It may be applicable to your own lipids situation.

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on October 23, 2011
at 04:22 PM

Al is an interesting dude. I think he is the ultimate biohacker. His insights are interesting reads for sure.

11838116de44ae449df0563f09bd3d73

(655)

on August 20, 2011
at 01:01 AM

Clearly you should send your labs to the oldest man alive.

1a98a40ba8ffdc5aa28d1324d01c6c9f

(20378)

on August 19, 2011
at 11:41 PM

I would for sure work on reversing the numbers. It does not mean that you already have CAC just that you are a canidate for it. I dont think your CRP number exonerates you. There are some simple tests for CAC including an ultrasound of neck arteries, a picture of your retna as well as a heart scan.

Af1d286f0fd5c3949f59b4edf4d892f5

(18472)

on August 19, 2011
at 10:55 PM

http://paleohacks.com/questions/58942/why-do-i-have-kidney-stones/59004#59004

Medium avatar

(39831)

on August 19, 2011
at 10:38 PM

I can't find a working copy of Masterjohn's K2 piece...did it move somewhere?

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on August 19, 2011
at 10:21 PM

If you have a low cardiac crp you generally are ok.....but IL 6 is very tied to hs crp.....best way to follow it is cimt and calcium index score really correlate well with real cardiac risk. Infect a lot better than Lpa or LDL levels. The best measures layer these together. HDL with hs crp cimt and calcium scores are really a great way to assess real risk.

Af1d286f0fd5c3949f59b4edf4d892f5

(18472)

on August 19, 2011
at 09:51 PM

Stephan made a strong case for this back in the day... http://wholehealthsource.blogspot.com/2009/03/latest-study-on-vitamin-k-and-coronary.html

3846a3b61bc9051e4baebdef62e58c52

(18635)

on August 19, 2011
at 09:34 PM

Agree, and I would also say that we keep looking for a one to one rational for disease processes. Its our reductionist mentality for health that keeps us looking for the one test for this disease, and one test for that disease. And when we can treat this disease x then we die from disease y instead at the same approximate rate (just now you paid a bunch of money not to die of x). Human physiology does not occur in a test tube and a reductionist view of it will never be able to explain or contribute to improving health.

Af1d286f0fd5c3949f59b4edf4d892f5

(18472)

on August 19, 2011
at 09:30 PM

Eric- I tested with high trigs, high VLDL, and low HDL, but very low CRP. Hence, the motivation behind my question here.

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7 Answers

best answer

5
3aea514b680d01bfd7573d74517946a7

(11996)

on August 19, 2011
at 09:23 PM

There's no way I can respond with the same erudition (real or otherwise) of the Mighty Might-o'chondri-AL, but I'll tell you what my (brand-new! yay!) doctor told me about the CRP test my (ex! yay!) doctor gave me while she was on her snipe hunt for Something, Anything Wrong With The Horrible Healthy Meat-Eater, God, Please:

It's a shiny new(ish) test that many doctors are enamored of because it's another data point and it occasionally corresponds with triglyceride readings and other potential cardiovascular markers. It also corresponds with tumors, infections, viruses, allergies, arthritis bouts, blisters, and rashes. And once in a while, nothing at all. In short, as a snapshot, it's not predictive, and it's barely indicative, unless it's hooked up with other, more positively correlated data. Because of its overgeneralized nature, in the absence of such correlated data, she considers it nearly useless.

If I'm reading his quote right, I think she'd agree with what Might-o'chondri-AL writes.

3846a3b61bc9051e4baebdef62e58c52

(18635)

on August 19, 2011
at 09:34 PM

Agree, and I would also say that we keep looking for a one to one rational for disease processes. Its our reductionist mentality for health that keeps us looking for the one test for this disease, and one test for that disease. And when we can treat this disease x then we die from disease y instead at the same approximate rate (just now you paid a bunch of money not to die of x). Human physiology does not occur in a test tube and a reductionist view of it will never be able to explain or contribute to improving health.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 24, 2011
at 05:00 AM

Well, here's one exception. If you're in the middle of an autoimmune attack (let's say RA), you could have very high CRP. How would you interpret that? Unless you tested for some autoimmune marker, you wouldn't know. But it would be one clue to continue the sleuthwork. ESR isn't as sensitive as CRP. That said, most internists and cardiologists don't bother with CRP, as they follow the Framingham checklist to measure other risk factors: for them ... the risk factors are smoking, BP, age, other medications, IR, etc. Inflammation is embedded in them, so they construe that to be overlapping.

3
3c6b4eed18dc57f746755b698426e7c8

on October 23, 2011
at 07:11 PM

I agree 100% with Al on CRP. CRP is not a specific marker and you should start your investigation by comparing it to other inflammation markers.

The problem here is CRP is being used as the only proxy for bodily inflmmation. Even being perfunctory, they could test for ESR or Sedimentation Rate, which is even more non-specific. But then what? You need to be able to move on to Il-6, fibrinogen, TNF, Ferritin, ANA and other autoimmune antibody tests ...

They just don't know enough: they do not know well enough about these new blood markers, and are only trained for specific treatment remedy via prescription. But then, most of them are following Best Practice protocols set up by their local boards anyway. These Best Practices themselves become ossified and change at a glacial rate. It takes 50 years to change. Or, as Taubes says, some of the pratcie leaders have to die for the standards to be tweaked.

Why test for CRP when you don't know what to do with it? The business model for doctors is to pigeonhole someone's complaint to a dozen disease patterns via very obvious blood markers. If a patient does not meet those blood markers, he doesn't really have to exert himself: why do that, unless you're a naturopath or an alternative practitioner? The Best Practices say do nothing. You're not gonna be sued for it, since no trial attorney could go against the established Best Practice protocols.

In fact, there is a business disincentive to doing anything proactive or using any new, emerging blood markers that go against traditional treatment. Patients themselves might resist in the end due to additional cost (Medicare and insurance qualifications, etc.). Insurance companies will balk. This keeps the incompetent in practice while the competent just gets by by keeping up with the herd.

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on October 23, 2011
at 07:15 PM

Namby HS crp is better but it still is only a start. Sadly if insurance did not dictate what we can order other labs would be ordered. That is not how things can be done.

2
77877f762c40637911396daa19b53094

(78457)

on October 23, 2011
at 10:41 AM

From his own comment:

I'm "semi-retired" 60 year old who hopes to avoid degeneration as I age. I've been investigating how to live well for over 40 years. Doc's blog appeals to me because he has clinical cases to draw on and good input from his readers. When I first began looking into things maintaining health the science was much different. I am just trying to organize my thoughts on contemporary research to preserve my mental capacity.

Yeah, great dude, I wonder why did he delete all WHS comments.

He doesn't post on all forums btw. It was only WHS and TrackYourPlegue. Recently I saw few comments on Quilts site.

77877f762c40637911396daa19b53094

(78457)

on October 23, 2011
at 05:59 PM

Yes, I collected some of them :)

77877f762c40637911396daa19b53094

(78457)

on October 24, 2011
at 09:02 AM

Not a fetish, just curiosity. I collect bunch of things, M-Al epic posts is just one of them.

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on October 23, 2011
at 04:22 PM

Al is an interesting dude. I think he is the ultimate biohacker. His insights are interesting reads for sure.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on October 24, 2011
at 05:39 AM

You seem to have a fetish on Mighty Al. I'm gonna have to warn him about finding a rabbit boiling in his kitchen.

1
792dc23355b30f0c5cdaf18191e2f2e8

on September 05, 2012
at 03:47 AM

Hi I am new here and somewhat puzzled I just did my routine exam and my total colessterol Came 168 HDL 60 LDL 98 triglycerides 48 which all Seem good however, my cardio CRP is 4.4!!! I do have a blister from running.... Otherwise ha ing an outstanding health immune system Healthy diet (mostly raw) etc. is it possible that the High crp was simply due to an overactive immune system??? Thanks

1
Da3d4a6835c0f5256b2ef829b3ba3393

on October 23, 2011
at 09:11 PM

I'm admittedly out of my depth here, but I've always seen inflammation and coronary calcium as independent and separate pathways to bad events happening in the body. Either one can lead to a heart attack, but you don't need both to have one. They cross paths in that way but aren't causative of one another.

1
Medium avatar

on August 19, 2011
at 09:35 PM

Wouldn't a deficiency in K-2 be the most likely cause of calcification of soft tissue? Seems like 100-200mcg a day would be sufficient.

Af1d286f0fd5c3949f59b4edf4d892f5

(18472)

on August 19, 2011
at 10:55 PM

http://paleohacks.com/questions/58942/why-do-i-have-kidney-stones/59004#59004

Af1d286f0fd5c3949f59b4edf4d892f5

(18472)

on August 19, 2011
at 09:51 PM

Stephan made a strong case for this back in the day... http://wholehealthsource.blogspot.com/2009/03/latest-study-on-vitamin-k-and-coronary.html

Medium avatar

(39831)

on August 19, 2011
at 10:38 PM

I can't find a working copy of Masterjohn's K2 piece...did it move somewhere?

0
1a98a40ba8ffdc5aa28d1324d01c6c9f

(20378)

on August 19, 2011
at 09:20 PM

I would look for high triglycerides, high VLDL and low HDL as indicators of CAC.

Af1d286f0fd5c3949f59b4edf4d892f5

(18472)

on August 19, 2011
at 09:30 PM

Eric- I tested with high trigs, high VLDL, and low HDL, but very low CRP. Hence, the motivation behind my question here.

1a98a40ba8ffdc5aa28d1324d01c6c9f

(20378)

on August 19, 2011
at 11:41 PM

I would for sure work on reversing the numbers. It does not mean that you already have CAC just that you are a canidate for it. I dont think your CRP number exonerates you. There are some simple tests for CAC including an ultrasound of neck arteries, a picture of your retna as well as a heart scan.

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