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Dr Anil Hingorani (Brooklyn, NY). While there has been a tremendous amount of data on CRP in the cardiology literature for the last 20 years, it really hasn’t had much clinical impact. How is this data going to change what you do every day to your patients undergoing lower extremity bypass procedures?

Dr Christopher D. Owens. I think that right now, we would be hesitant to make any recommendations based on 91 patients other than pointing out that our median hsCRP level was 3.2 mg/L, which is high risk. Five mg/L, which was our lab’s cutoff, may be a little bit too high. Once we get more patients, we may be able to place these in tertiles or quartiles and refine the predictive ability. Depending on the difference between the highest and lowest quartile, there may be an opportunity for treatment. As you know, there is beneficial data on statins lowering CRP and improving cardiovascular outcomes. And if that is true, CRP is a biomodulator, not just a biomarker, and that may have direct clinical impact in terms of decreasing progressive atherosclerosis or decreasing vein graft hyperplasia. So it may be an area for pharmaceutical intervention.