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From a clinical perspective, the best way to understand these data is to use our best lipid marker, the total cholesterol:HDL cholesterol ratio, and simultaneously assess the hs-CRP level. In another analysis from the Physicians' Health Study, there is a clear interaction between the hs-CRP levels and the total cholesterol:HDL cholesterol ratio, indicating that using both these parameters appears to do a better job of predicting risk than using either alone. These data are also important at another level. Current recommendations for primary prevention focus largely on lipid screening, which is highly effective in detecting individuals at risk. However, as shown in this slide, there are many individuals with moderate cholesterol levels who nonetheless are at high risk and might have been identified with combined CRP and cholesterol screening.

Ridker PM, Glynn RJ, Hennekens CH. C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction. Circulation 1998;97:2007-2011.
WebsiteRier PM et al. Circulation 1998;97:2007-2011.a 1998 Lippincott Williams & Wilkins.