C Reactive Protein (CRP) and inflammation

General Health

Medichecks doctor Emil Hodzovic explains what inflammation is, what causes it and how you can measure your inflammation levels at home.

30/05/2019


Emil Hodzovic
MBBCh

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What is inflammation?

Inflammation in the basic sense is the body’s defence mechanism, whether this is to an illness or injury. It is a natural response and occurs soon after the injury or illness occurs with the aim of removing the problem (bacteria or foreign body for example) to allow healing to occur. [1]

How do we measure inflammation?

Generally speaking, inflammation is identified by symptoms including redness, heat, swelling, pain and loss of function of the affected area (think of a sore throat or infected cut). However, sometimes, it is not immediately obvious and blood tests can help to identify or quantify it. One of these blood tests, the C-Reactive Protein (CRP), is used regularly within a medical setting as a measure of infection, inflammation and also to gauge the effectiveness of treatments, usually alongside other markers.

What is the CRP?

The CRP is a substance released by the liver in response to inflammation. It is activated by certain white cells and attaches to both bacteria and dead or dying cells to further activate the bodies response to the offending stimulus. This means that it both acts as a measure of inflammation but also contributes to it by encouraging a further response from the body in a bid to ‘tidy up’ the debris that occurs alongside healing.

Usually, in healthy individuals, it is present at very low levels in the blood and as levels get higher, this usually indicates proportionally greater levels of inflammation. Unfortunately, it is non-specific so it can’t be used to pinpoint the source of the inflammation and if there are multiple things going then it can get more complicated. This can mean that an overt source of inflammation can mask something else which is why we often request further tests when we find a raised CRP on a blood test to ensure that it returns to normal levels.

At Medichecks we offer a special type of CRP known as a high sensitivity CRP (hs-CRP). A normal CRP test has a cut-off, above which we class the result as ‘inflammation’ and below which is normal. The high sensitivity test goes into more detail and can detect levels within the normal range. Levels approaching the top of the normal of the range can be classed as chronic low-grade inflammation if they are persistent and this can be a sign of increased risk of cardiovascular disease.

What is chronic inflammation?

When inflammation persists, for example, for months to years, it is termed chronic inflammation. There can be a number of reasons for inflammation persisting. For example, it can be due to the defence mechanisms of the offending organism being able to resist the bodies attempts to remove it or it can be caused by constant low-level exposure to the irritant, for example, inhaled dust. Auto-immune conditions such as lupus, where the body attacks its own healthy tissue will also cause long term inflammation.

CRP, chronic inflammation and CVD

Cardiovascular disease manifests as the build-up of fatty plaques on the inside of arteries around the body. There are many risk factors for the formation of these plaques including high blood pressure, raised cholesterol, poor diet, smoking and inadequate levels of physical activity. These all contribute in different ways but ultimately this build up is a chronic inflammatory process [3]. It, therefore, follows that measures of inflammation can be used to track this. However, it is only recently, that hs-CRP has become established as an independent marker of risk in its own right. In otherwise healthy individuals, a raised hs-CRP was found to be predictive of an increased risk of a wide range of medical conditions including cardiovascular disease, even when cholesterol levels are within an acceptable range [4]

It is less clear however whether CRP is merely a marker of risk or whether it actually contributes to cardiovascular disease in its own right [5]. This is largely academic at this stage and although it may mean that new treatments and interventions may become available in the future, this is a long way off. What we do know is that if a chronic low level of inflammation is suspected then it is worth taking extra precautions toward managing other known risk factors as outlined above.

Controlling inflammation

As well as cardiovascular disease, chronic inflammation can be associated with a huge number of lifestyle and age-related diseases including cancer, diabetes, autoimmune conditions [6,7,8] and even obesity [9]. This means that controlling inflammation by managing it’s risk factors is of vital importance, alongside specific treatments for medical conditions as needed. Of the risk factors mentioned above, raised blood pressure and high cholesterol are generally more specific to cardiovascular disease as they cause direct damage to blood vessels and therefore promote inflammation leading to strokes and coronary artery disease.

The other risk factors are much more general and apply to a wide range of disease. Smoking floods the body with toxins and causes widespread inflammation. As well as being a specific risk factor for cardiovascular disease it also damages lungs and can be implicated in a huge range of cancers [10].

  • Exercise is one of the best ways that you can control inflammation and it doesn’t have to be intense or prolonged. The NHS recommends 150 minutes of moderate physical activity a week and this can include cycling or brisk walking [11].
  • A healthy diet can also reduce inflammation significantly and although there is a lot of conflicting information out the general consensus is that eating plenty of vegetables is very important. On top of this controlling your calorie intake, getting enough fibre in and drinking plenty of water will also help.
  • Obesity and diabetes are also independent risk factors for inflammation and disease so by ensuring that you are exercising regularly, controlling your body weight and eating well, you will help reduce these as well as these activities being beneficial in their own right.
  • Finally, stress, when chronic, can also contribute as a risk factor for a whole host of diseases associated with inflammation [12]. Again, diet and exercise can be powerful moderators of stress and practices such as (but not limited to) taking time for hobbies, social time [13] and meditation [14].

Check your inflammation levels

If you are interested in measuring and monitoring your inflammation levels, our high sensitivity CRP (hs-CRP) test which can be taken in the comfort of your own home is on offer throughout June. Also, stay tuned for next week's newsletter where we will explaining more about the best anti-inflammatory foods to help to prevent or reduce inflammation in the body. 


References

1.    Chen, L., Deng, H., Cui, H., Fang, J., Zuo, Z., Deng, J., … Zhao, L. (2018). Inflammatory responses and inflammation-associated diseases in organs. Oncotarget. https://doi.org/10.18632/oncotarget.23208
2.    Lawrence, T., & Gilroy, D. W. (2007). Chronic inflammation: a failure of resolution?. International journal of experimental pathology, 88(2), 85-94.
3.    Andreou, D. E., & Andreadou, I. (2009). Atherosclerosis: An inflammatory disease. Pharmakeftiki. https://doi.org/10.1016/S0268-9499(96)80718-1
4.    Nilsson, J. (2005). CRP - Marker or maker of cardiovascular disease? Arteriosclerosis, Thrombosis, and Vascular Biology. https://doi.org/10.1161/01.ATV.0000174796.81443.3f
5.    Willerson, J. T. (2004). Inflammation as a Cardiovascular Risk Factor. Circulation. https://doi.org/10.1161/01.CIR.0000129535.04194.38
6.    Hunter, P. (2012). The inflammation theory of disease. the growing realization that chronic inflammation is crucial in many diseases opens new avenues for treatment. EMBO Reports. https://doi.org/10.1038/embor.2012.142
7.    Khansari, N., Shakiba, Y., & Mahmoudi, M. (2009). Chronic Inflammation and Oxidative Stress as a Major Cause of Age- Related Diseases and Cancer. Recent Patents on Inflammation & Allergy Drug Discovery. https://doi.org/10.2174/187221309787158371
8.    Shacter, E, S. W.-W. P. (2002). Chronic inflammation and cancer. DiagnosticImaging.Semanticscholar.Org. https://doi.org/10.1016/j.radi.2011.05.002
9.    Monteiro, R., & Azevedo, I. (2010). Chronic inflammation in obesity and the metabolic syndrome. Mediators of Inflammation. https://doi.org/10.1155/2010/289645
10.    What are the health risks of smoking? (2018). Retrieved February 4, 2019, from https://www.nhs.uk/common-health-questions/lifestyle/what-are-the-health-risks-of-smoking/
11.    Physical activity guidelines for adults. (2018). Retrieved February 4, 2019, from https://www.nhs.uk/live-well/exercise/
12.    Liu, Y.-Z., Wang, Y.-X., & Jiang, C.-L. (2017). Inflammation: The Common Pathway of Stress-Related Diseases. Frontiers in Human Neuroscience. https://doi.org/10.3389/fnhum.2017.00316
13.    Moodzone: 10 Stress Busters. (2018). Retrieved February 4, 2019, from https://www.nhs.uk/conditions/stress-anxiety-depression/reduce-stress/
14.    Economides, M., Martman, J., Bell, M. J., & Sanderson, B. (2018). Improvements in Stress, Affect, and Irritability Following Brief Use of a Mindfulness-based Smartphone App: A Randomized Controlled Trial. Mindfulness. https://doi.org/10.1007/s12671-018-0905-4


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