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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Tuesday, January 28, 2003

    Reactive: C-reactive protein, that hot new test which is hyped so well by its lead researcher (and patent holder) has been scrutinized by the American Heart Association. Their recommendations? Depends on which account you read. ABC news (via the Associated Press) says the AHA proclaimed, "Docs Urged to Test for Heart Inflammation", but UPI gets the story right - "Experts downplay heart test value":

    A new and widely used blood test might be of only limited value in assessing heart disease risk, experts reported Monday.

    In an article to be published in the Jan. 28 issue of the journal Circulation, a panel convened by the American Heart Association and the Centers for Disease Control and Prevention concluded that the C-reactive protein, or CRP, test be used only in addition to cholesterol testing and blood-pressure screening and only in specific diagnostic situations

    ...The panel members emphasized they do not consider the new test as diagnostically important as cholesterol testing or high blood pressure screening. For most patients, they concluded, the emphasis must remain on detection, treatment, and control of the major risk factors, such as high blood pressure, high blood cholesterol, cigarette smoking and diabetes.

    To be fair, the ABC story mentions that the test isn’t recommended for widespread screening, but you have to read through five paragraphs to get to that part.

    The guidlines are here, and they mention the following drawbacks:

    -Current assays are not specific for atherosclerosis and thus are not useful in the setting of other systemic inflammatory or infectious processes.

    -..there remains much to learn about optimizing its application to risk assessment.

    -On the basis of the available evidence, the Writing Group recommends against screening of the entire adult population for hs-CRP as a public health measure.

    -At the discretion of the physician, the measurement is considered optional, based on the moderate level of evidence (Evidence Level C). In this role, hs-CRP measurement appears to be best employed to detect enhanced absolute risk in persons in whom multiple risk factor scoring projects a 10-year CHD risk in the range of 10% to 20% (Evidence Level B). However, the benefits of this strategy or any treatment based on this strategy remain uncertain.
    [emphasis mine]

    -These recommendations should not be interpreted to mean that the scientific evidence is fully adequate. Randomized trials in which inflammatory marker testing was the primary intervention have not been performed to provide Level A evidence, nor have cost-effectiveness analyses been completed to assess additional costs or cost savings through the use of such tests.

    Hardly an urgent call to test for heart inflammation. Someone at the Associated Press (and ABC) needs to take more care when reading press releases

    posted by Sydney on 1/28/2003 07:11:00 AM 0 comments


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