C-reactive protein as a risk predictor: do race/ethnicity and gender make a difference?

Case presentation: M.A. is a 43-year-old female AfricanAmerican airline pilot with a family history of stroke and insulindependent diabetes who comes to the cardiovascular clinic for a routine yearly physical required by her employer. She is asymptomatic and physically active as the mother of 2 young sons (aged 3 and 8 years). She is concerned about her risk for stroke and a heart attack because of her mother’s death from a stroke at age 55. She also has a 49-year-old brother who was recently hospitalized with heart failure. She has no significant past medical history and takes no medications. M.A. does not smoke, drink alcohol, or use illicit drugs. On physical examination, she has a systolic blood pressure of 160 mm Hg and a diastolic blood pressure of 95 mm Hg bilaterally. Her heart rate is 86, and respirations and oxygen saturation are within normal limits. Her weight is 170 lb and height is 6 ft. The remainder of her physical examination is also within normal limits. Testing performed included a 12lead ECG that demonstrates sinus rhythm at 86 beats per minute and left ventricular hypertrophy and fasting lipid profile that shows a total cholesterol level of 208 mg/dL, LDL cholesterol level of 135 mg/dL, HDL cholesterol level of 52 mg/dL, and triglycerides of 142 mg/dL. Her highsensitivity C-reactive protein (hs-CRP) level is 4.5. What advice would you give to M.A. with regard to her concerns about her risk for cardiovascular disease?