CRP vs. Cholesterol: Which Better Predicts Heart Disease?

Both are independent risk markers; they reflect different pathways.

C-Reactive Protein (CRP)

• Marker of systemic inflammation (atherosclerosis is inflammatory).
• High-sensitivity CRP (hs-CRP) >2 mg/L = higher CV risk.
• Identifies risk in people with normal LDL.
• Influenced by obesity, smoking, infections, autoimmune disease.

LDL Cholesterol

• Directly deposits in arterial intima → plaque formation.
• Primary target for therapy (statins, ezetimibe, PCSK9 inhibitors).
• Causal, not just associative.

Combined Assessment

Guidelines (ACC/AHA, ESC) recommend using both (plus BP, diabetes, smoking, family history) in risk calculators (Pooled Cohort Equations, SCORE2). Elevated CRP + high LDL = highest risk.

Neither replaces the other; they complement.