Is high CRP cause for concern?
DEAR DR. ROACH: For the past six years, every time I have my annual labs done, my CRP has been very high. Normal range is listed as 0-3 mg/L. My results have consistently been 7-10 mg/L or more. When I express concern that this is listed as putting me at high risk for a cardiac event, I am always brushed off and told I just have internal inflammation, a cold or a cut somewhere.
Should I be worried about years of a high CRP level damaging my heart? I am on 10 mg atorvastatin, and my cholesterol levels are all being maintained within normal range, so that's covered. -- P.C.
ANSWER: Inflammation is known to be a risk factor for development of heart disease and stroke. People with inflammatory conditions, such as rheumatoid arthritis or lupus, have a higher risk of heart attack than would be expected based on their blood pressure, cholesterol and family history (among other risk factors). There are theories, but it is not clear exactly how inflammation translates to vascular disease.
The C-reactive protein is an established blood test to evaluate inflammation. A highly sensitive CRP test can measure a CRP of <0.3 mg/L, which puts someone at low risk for heart disease. A level above 3 is called high risk; however, the magnitude of that risk is much smaller than other risk factors, such as blood pressure and cholesterol.
A trial showed that people with low-normal cholesterol but high CRP levels did benefit from a statin drug. Statins, in addition to lowering cholesterol, also lower CRP levels. However, subsequent analysis has suggested that people who are otherwise at low risk for heart disease also have low risk from just an elevated CRP, and thus get little benefit from a statin drug.
In people at intermediate risk, the CRP can help determine if a statin is worth taking. A low CRP is somewhat reassuring, while a high CRP might push me to recommend a statin. I do not order CRP levels on people who are otherwise at low risk.
DEAR DR. ROACH: Should a "junior-senior male" (age 75) be concerned about increasing urination, both at night, with normal prostate-related issues, but also during the daytime? Does one have to compensate and drink more fluids? Is there a danger in not having enough fluids in the system? -- A.S.
ANSWER: Most men in their 60s and older do notice that the urine flow is slower than before, and sometimes it becomes difficult to empty the bladder entirely. This leads to more frequent bathroom trips but with somewhat lower volume. And as you say, it's most commonly due to enlarged prostate. The total amount of volume coming out stays the same, and is equal to the amount of volume coming in (minus what is lost through sweat and other smaller losses). You do not need to increase your fluid intake. Treatment is to shrink the prostate, which may require medication or sometimes a surgical procedure.
Very large amounts of urine suggest a separate cause. In diabetes, excess blood sugar carries water out of the body. Diabetes insipidus is most commonly caused by the loss of anti-diuretic hormone and inability for the body to properly regulate sodium and water balance. These possibilities can be easily evaluated by your regular doctor.
Finally, what seems like prostate problems can sometimes be a bladder issue: If prostate treatment isn't working, it might be time to see a urologist for further evaluation.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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