Meta-analyses consistently demonstrate that the magnitude of risk prediction associated with high-sensitivity C-reactive protein (CRP) is similar to if not greater than that of cholesterol and blood pressure. I leave it up to individual physicians to decide whether a novel risk marker with an effect as large as that of these established risk markers is “major” or not.

Contrary to what is stated, those with rheumatoid arthritis have higher levels of high-sensitivity CRP and higher levels of vascular risk. Patients with lupus who are well known to have high vascular risk represent an exception that proves the rule: those with systemic lupus erythematosus often have anti-CRP antibodies that provide false low levels using standard CRP tests.

I concur with Dr. Feeman that lipid ratios perform better than when individual lipid values are used in isolation, and my practice is to use either the ratio of total to high-density lipoprotein cholesterol or non–high-density lipoprotein cholesterol, both of which work well. However, as has been repeatedly shown, >1/2 of all heart attacks occur in patients with low-density lipoprotein cholesterol levels <130 mg/dl. This is why we conducted Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER), in which we observed that statin therapy given to those with low-density lipoprotein cholesterol levels <130 mg/dl but high-sensitivity CRP levels >2 mg/L reduced first ever myocardial infarction or stroke by half.