Inflammation plays a critical role in cardiovascular (and overall) health. It serves as both a driver and indicator of conditions like atherosclerosis (plaque buildup in your arteries) and heart disease that may not be apparent from the outside. 

Among biomarkers used to assess inflammation, C-reactive protein (CRP) is known for its ability to reflect your body’s inflammatory response. High-sensitivity CRP (hs-CRP or HSCRP) is a more precise version of this test. It’s being used to predict cardiovascular risk by detecting subtle, chronic inflammation that may contribute to heart attacks, strokes, and other serious cardiac events. 

Let’s explore hs-CRP further, including how it can provide valuable insights into your cardiovascular health and disease prevention.

CRP vs. hs-CRP: Key Differences

First things first: You may have heard both of these terms but what’s the difference between CRP and hs-CRP? 

CRP is a substance produced by the liver in response to inflammation anywhere in the body, making it a general marker used to detect infections, chronic inflammatory conditions, or tissue injury. 

hs-CRP, or high-sensitivity C-reactive protein, is also sometimes called cardio CRP. It’s a more refined version of this test, capable of detecting much lower levels of CRP in the bloodstream. This increased sensitivity allows hs-CRP to identify subtle inflammatory changes associated with the development of cardiovascular disease. 

Unlike traditional CRP tests, which are better for acute inflammation, hs-CRP focuses specifically on low-grade, chronic inflammation linked to atherosclerosis and other heart health risks. This makes it a valuable tool for predicting heart attacks, strokes, and other cardiac events.

What is the Role of hs-CRP in Cardiovascular Health?

hs-CRP plays a critical role in monitoring your cardiovascular health because it serves as a marker of low-grade inflammation that can be associated with the development and progression of cardiovascular disease. 

Chronic low-grade inflammation plays a role in atherosclerosis, which increases your risk of having a stroke or a heart attack. 

Numerous studies have shown that elevated hs-CRP levels are strongly linked to a higher likelihood of CVD events, even in individuals without other traditional risk factors. For example, research from the New England Journal of Medicine has highlighted hs-CRP as a reliable predictor of first-time cardiovascular events—like a heart attack or stroke. 

Furthermore, we even see studies showing that if LDL “bad” cholesterol is low, but hs-CRP is high, this increases the risk of cardiovascular events significantly. For example, one 2018 study discussed how, even though lowering high LDL is important for reducing cardiovascular risk, understanding hs-CRP and managing your inflammation is equally if not more critical. 

The hs-CRP Blood Test

Having a hs-CRP blood test is pretty simple, like other bloodwork, and requires little preparation on your part. To avoid temporarily elevating your CRP levels before this test, you might be advised not to smoke or engage in strenuous exercise ahead of the test. 

hs-CRP levels are typically measured in milligrams per liter (mg/L): 

• Levels below 1 mg/L indicate low cardiovascular risk
• Levels within 1–3 mg/L suggest average risk
• Levels above 3 mg/L indicate high risk

It’s helpful to know that hs-CRP levels can be influenced by factors such as acute infections, chronic inflammatory conditions (like arthritis), and lifestyle factors like obesity, smoking, and ongoing mental and/or physical stress. 

Additionally, CRP is usually measured to detect and monitor short-term inflammation caused by infections (like viral illness) or autoimmune diseases. hs-CRP might increase during infections but is designed to detect low-grade inflammation, which is not typically caused by acute infections but rather chronic inflammatory processes—like those linked to cardiovascular disease.

Managing Elevated hs-CRP Levels

If you have elevated hs-CRP levels, this is a great opportunity to assess your lifestyle habits and identify areas for improvement. It’s also important to assess what might be promoting inflammation in your body. 

For example, do you have a larger waist circumference that’s causing more inflammatory cytokines to be released? Are you dealing with poorly controlled acid reflux, digestive health issues, or inflammatory skin conditions like psoriasis? Has your doctor ever tested for other high uric acid, fibrinogen, or homocysteine that can contribute to inflammation in the body? These are all important things to take into consideration as they may be playing an underlying role in your body’s inflammatory response.

Nutrition, exercise, and stress reduction are three of the main areas I like to look at with my clients to help reduce overall inflammation and cardiovascular risk. Once you have an idea of what’s promoting inflammation in your body, we can tailor changes in these areas to your personalized needs. 

Diet and Nutrition

hs-CRP can be reduced significantly with an appropriate diet that addresses the underlying root causes. Personalized science-based nutrition is my focus with my clients and, when we’re looking to target inflammation, I often reference the Dietary Inflammation Index (DII). 

This is a tool designed to help us assess the inflammatory potential of your diet. It assigns scores to foods and nutrients based on their ability to increase or decrease inflammation. The DII was developed using scientific evidence linking dietary components to markers of inflammation, such as hsCRP.

I like using the DII because it focuses more on what foods you can add to your diet to help reduce inflammation than foods to remove. 

Some of the best inflammation-reducing foods include: 

• Fatty fish (salmon, mackerel, sardines, trout)
• Nuts, like cashews, walnuts, and almonds
• Berries
• Ginger
• Leafy greens, like spinach and romaine
• Cruciferous veggies, like broccoli, cauliflower, kale, and Brussels sprouts
• Green tea, which is high in antioxidant catechins like EGCG
• Turmeric
• Tomatoes
• Extra virgin olive oil
• Dark chocolate, ideally 70% cacao or higher

These items are low in saturated fat (with fish, nuts, and olive oil providing healthy fats) and are nutrient-dense, providing an array of vitamins, minerals, fiber, and antioxidants that help protect cellular health and manage inflammation. 

Exercise and Weight Management

Engaging in regular physical activity helps support healthy weight management and reduce inflammatory biomarkers, which are important for your cardiovascular health. Exercise helps keep systemic inflammation in check by reducing visceral fat, improving insulin sensitivity, and increasing your body’s production of anti-inflammatory cytokines. 

Some good examples of aerobic exercises include: 

• Brisk walking or jogging
• Bicycling
• Swimming
• Playing tennis
• Rollerblading

In addition to aerobic exercises, it’s important to do strength training at least twice per week. This could mean lifting dumbbells, using weight machines and resistance bands, or doing bodyweight exercises like push-ups and squats to preserve and build lean muscle mass. 

Stress Management and Sleep

We’re all affected by stressors. While we can’t always avoid them, it’s important to know how to manage stress well through everyday habits and improving our sleep. Chronic stress triggers the release of stress hormones like cortisol, which, when elevated over time, can promote systemic inflammation and raise levels of hs-CRP. 

If you could use some help in the stress management department, here are some ideas: 

• Deep breathing exercises
• Mindfulness meditation 
• Yoga
• Spending intentional time in nature
• Taking a walk
• Listening to calming music

Similarly, poor sleep disrupts your body’s natural repair processes, leading to elevated inflammation and an increased risk of cardiovascular issues. Experts recommend adults get 7-8 hours of restful sleep each night. Having a consistent sleep-wake cycle, avoiding screens, alcohol, caffeine, and heavy meals right before bed, and designing a calm sleep environment can help. 

Client Success Story

A 55-year-old woman with a strong family history of heart disease, a high lipoprotein(a), an abnormally advanced lipid panel, and plaque found in her LAD came to see me for personalized advice to improve her cardiovascular disease and prediabetes without medication.

At first, her hsCRP was 6.5mg/L, HgA1c was 5.6% (prediabetes is 5.7% or higher), and her LDL pattern was B (her LDL is smaller and denser, more susceptible to plaque formation in the arteries).

She worked with me in the 4-month VIP 1-on-1 program and the 3-month extension program afterward, during which we worked on improving her diet and lifestyle, reducing her risk of heart disease, and stopping the progression of coronary artery disease.

In 6 months, her HgA1c decreased to 5.3%, her hsCRP to 1.0, and her LDL pattern changed to type A (which is less atherogenic because they are larger and less susceptible to creating plaque in the arteries!)

Not only has she optimized her risk profile, she has gained back more energy, better sleep quality, and a better sex life with her husband. She has reduced her health anxiety and feels empowered to live a long and healthy life alongside her family.

Putting It All Together: hs-CRP and Your Heart 

While hs-CRP is a very useful risk assessment tool, heart disease has many risk factors—and it’s essential that we examine all of them, like cholesterol, ApoB, and calcium score. Inflammation is particularly important because it wreaks havoc on the arteries and accelerates all heart-related conditions. 

Meeting with a cardiovascular dietitian is a great step toward identifying underlying inflammatory triggers and making personalized changes with science-based nutrition. Learn about my 1:1 counseling or click here to schedule a complimentary 15-minute discovery call to discuss how we can work together.

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