Preanalytic and analytic sources of variations in C-reactive protein measurement: implications for cardiovascular disease risk assessment

Background: C-reactive protein (CRP) is a widely rec-ognized indicator of inflammation and is known to play an important role in atherogenesis. Recent prospective studies have demonstrated that increased CRP concen-trations within the reference interval are a strong pre-dictor of myocardial infarction, stroke, sudden cardiac death, and peripheral vascular disease in apparently healthy adults. On the basis of available evidence, the American Heart Association and the CDC have issued guidelines for the utility of CRP in the primary preven-tion of coronary heart disease and in patients with stable coronary disease or acute coronary syndromes. Never-theless, there remains considerable work to optimize the utility of this marker for risk assessment. Issues: Most traditional CRP tests designed to monito