How C-reactive protein outpaced ‘bad’ cholesterol as leading heart disease risk marker

Mary J. Scourboutakos, Macon & Joan Brock Virginia Health Sciences at Old Dominion University Heart disease is the leading cause of death in the United States. Since researchers first established the link between diet, cholesterol and heart disease in the 1950s, risk for heart disease has been partly assessed based on a patient’s cholesterol levels, which can be routinely measured via blood work at the doctor’s office. However, accumulating evidence over the past two decades demonstrates that a biomarker called C-reactive protein – which signals the presence of low-grade inflammation – is a better predictor of risk for heart disease than cholesterol. As a result, in September 2025, the American College of Cardiology published new recommendations for universal screening of C-reactive protein levels in all patients, alongside measuring cholesterol levels.

What is C-reactive protein?

C-reactive protein is created by the liver in response to infections, tissue damage, chronic inflammatory states from conditions like autoimmune diseases, and metabolic disturbances like obesity and diabetes. Essentially, it is a marker of inflammation – meaning immune system activation – in the body. C-reactive protein can be easily measured with blood work at the doctor’s office. A low C-reactive protein level – under 1 milligram per deciliter – signifies minimal inflammation in the body, which is protective against heart disease. An elevated C-reactive protein level of greater than 3 milligrams per deciliter, signifies increased levels of inflammation and thus increased risk for heart disease. About 52% of Americans have an elevated level of C-reactive protein in their blood. Research shows that C-reactive protein is a better predictive marker for heart attacks and strokes than “bad,” or LDL cholesterol, short for low-density lipoprotein, as well as another commonly measured genetically inherited biomarker called lipoprotein(a). One study found that C-reactive protein can predict heart disease just as well as blood pressure can.

Why does inflammation matter in heart disease?

Inflammation plays a crucial role at every stage in the development and buildup of fatty plaque in the arteries, which causes a condition called atherosclerosis that can lead to heart attacks and strokes. From the moment a blood vessel is damaged, be it from high blood sugar or cigarette smoke, immune cells immediately infiltrate the area. Those immune cells subsequently engulf cholesterol particles that are typically floating around in the blood stream to form a fatty plaque that resides in the wall of the vessel. This process continues for decades until eventually, one day, immune mediators rupture the cap that encloses the plaque. This triggers the formation of a blood clot that obstructs blood flow, starves the surrounding tissues of oxygen and ultimately causes a heart attack or stroke. Hence, cholesterol is only part of the story; it is, in fact, the immune system that facilitates each step in the processes that drive heart disease.

Can diet influence C-reactive protein levels?

Lifestyle can significantly influence the amount of C-reactive protein produced by the liver. Numerous foods and nutrients have been shown to lower C-reactive protein levels, including dietary fiber from foods like beans, vegetables, nuts and seeds, as well as berries, olive oil, green tea, chia seeds and flaxseeds. Weight loss and exercise can also reduce C-reactive protein levels.

Does cholesterol still matter for heart disease risk?

Though cholesterol may not be the most important predictor of risk for heart disease, it does remain highly relevant. However, it’s not just the amount of cholesterol – or more specifically the amount of bad, or LDL, cholesterol – that matters. Two people with the same cholesterol level don’t necessarily have the same risk for heart disease. This is because risk is determined more so by the number of particles that the bad cholesterol is packaged into, as opposed to the total mass of bad cholesterol that’s floating around. More particles means higher risk. That is why a blood test known as apolipoprotein B, which measures the number of cholesterol particles, is a better predictor of risk for heart disease than measurements of total amounts of bad cholesterol. Like cholesterol and C-reactive protein, apolipoprotein B is also influenced by lifestyle factors like exercise, weight loss and diet. Nutrients like fiber, nuts and omega-3 fatty acids are associated with a decreased number of cholesterol particles, while increased sugar intake is associated with a larger number of cholesterol particles. Furthermore, lipoprotein(a), a protein that lives in the wall surrounding cholesterol particles, is another marker that can predict heart disease more accurately than cholesterol levels. This is because the presence of lipoprotein(a) makes cholesterol particles sticky, so to speak, and thus more likely to get trapped in an atherosclerotic plaque. However, unlike other risk factors, lipoprotein(a) levels are purely genetic, thus not influenced by lifestyle, and need only be measured once in a lifetime.

What’s the best way to prevent heart disease?

Ultimately, heart disease is the product of many risk factors and their interactions over a lifetime. Therefore, preventing heart disease is way more complicated than simply eating a cholesterol-free diet, as once thought. Knowing your LDL cholesterol level alongside your C-reactive protein, apolipoprotein B and lipoprotein (a) levels paints a comprehensive picture of risk that can hopefully help motivate long-term commitment to the fundamentals of heart disease prevention. These include eating well, exercising consistently, getting adequate sleep, managing stress productively, maintaining healthy weight and, if applicable, quitting smoking. Mary J. Scourboutakos, Adjunct Assistant Professor in Family and Community Medicine, Macon & Joan Brock Virginia Health Sciences at Old Dominion University This article is republished from The Conversation under a Creative Commons license. Read the original article.

How to reduce gift-giving stress with your kids – a child psychologist’s tips for making magic and avoiding tears

Angela J. Narayan, University of Denver As a child, I loved being the center of attention. So it was a problem when my baby brother was born a day before my birthday. For years, I would beg my parents for a birthday gift “one day early.” My laid-back brother remembers thinking, “I don’t care about presents. Just give her mine!” As an associate professor and child psychologist at the University of Denver who studies child development and parenting, I’ve come to learn about these types of challenges associated with gift giving. The holidays, while a magical time, can also be stressful. Society places an expectation on parents to buy gifts, regardless of their financial circumstances, and children themselves often feel a variety of complex emotions. How children react to getting presents is partially linked to temperament, which is the variety of ways that children experience, perceive and interact with the world. Temperament is the precursor to personality – some people are introverts, while others are extroverts. Temperament is partially heritable. That means an introverted parent who feels social pressure to buy many gifts for their shy and easily overwhelmed child may be inadvertently causing stress. Faced with this holiday conundrum, I’m often asked questions like “Is there a magic number of gifts to give my kids?” or “What gifts will hold my child’s attention the longest?” While there isn’t an easy answer to either question, these tips and tricks can help parents be more thoughtful and intentional about gift giving, especially for children who are young.

The age rule

Young children cannot focus on a lot of things at once. A good rule of thumb is that a 1-year-old can focus only on one thing at a time. A 2-year-old can maybe focus on two things at most, and a 3-year-old maybe three things, and so on. Stop at five. Very few children actually need more than five gifts, so feel free to go lower.

The attention rule

I have often searched for the magical gift that will keep my children occupied for hours, and so far I haven’t found it. What I have found is that my children – ages 5 and 7 – get excited about the things that I get excited about. So I try to buy things that I think are fun. Ask yourself what you would like to play with if you got to be a child again. I bet your children would be eager to join you in those things.

The games rule

Card and board games are great gifts, often inexpensive, fun for many ages – excepting babies, of course – and capable of holding attention for a long time. Plus, they usually don’t take up much storage space. I love giving my kids games that are not only fun but also teach them helpful skills. Collaborative games for preschoolers and early school-age children like the Fairy Game and Outfoxed teach problem-solving, teamwork and early reasoning skills. Games for elementary-age children, such as Sorry and Battleship, teach kids how to manage difficult situations, like not always being in the lead, being a good sport even if you’re behind, and losing gracefully. Timeless card games like Uno and Memory, and newer ones like Sleeping Queens and Exploding Kittens, are great for using working memory, thinking flexibly, persisting and strategizing. Most importantly, playing games together supports positive family time, which is an excellent antidote to stress, bad moods or boredom.

The pressure rule

Imagine the holiday experience through the eyes of each of your children. Some children relish receiving gifts, like I did. Others, however, may feel self-conscious, overwhelmed by the sensory overload – all the textures, commotion and bright colors, not to mention people staring at them. The elements of surprise combined with the unspoken social pressure to be gracious and well regulated are challenging for any young child. We expect small children to contain their excitement, delay gratification and react positively to the surprise. And then come up with a polite response. These are all complex requests, rarely directly or explicitly taught. It’s no wonder that many children show negative emotions, have tantrums, or even just say, “I’m tired!” during holiday celebrations. That’s why beyond the precise nature of “the perfect gift,” we shouldn’t lose sight of what we should be doing. And that is investing in togetherness and helping kids learn skills like being patient and taking turns, strengthening memory capacities, planning ahead, not giving up, and that being a team player will pay off later. These skills pave the way for longer sustained attention, focus and concentration, as well as confidence. My 7-year-old is becoming a skillful chess player because we have taught him the rules and strategy and helped him practice. Maybe this is the real magical gift – not the purchase itself, but the decision to invest in time with your child early. Angela J. Narayan, Associate Professor, Clinical Child Psychology Ph.D. program, University of Denver This article is republished from The Conversation under a Creative Commons license. Read the original article.