Running head: C-REACTIVE PROTEIN
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C-Reactive Protein and Peripheral Vascular Disease
Courtney List
Ferris State University
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C-Reactive Protein and Peripheral Vascular Disease
As the average life expectancy of the population American increases so does the average
age of the population. Increased age places people at higher risks for developing several
cardiovascular complications including coronary artery disease, thromboembolic stroke,
myocardial infarction or peripheral arterial disease. Ridker and colleagues conducted a study
hypothesizing a positive correlation between C-reactive protein (CRP) and increased risk for
developing peripheral arterial disease (PAD). This paper will discuss the results of Ridker’s
study and its effects on nursing practice.
Peripheral arterial disease is a common condition affecting many people in the geriatric
community in the United States. It can lead to further complications including intermittent
claudication, chronic lower extremity ischemia, recurrent infections, need for surgical
revascularization and in the most severe cases limb loss (Ridker et al., 2012). Ridker and
colleagues studied whether or not increased C-reactive protein levels, an indicator of systemic
inflammation, could be used as a molecular indicator of increased risk for PAD. Recent studies
have shown that systemic inflammation places people at higher risk for myocardial infarctions
and having a thromboembolic stroke, however, there is little data to show a relationship between
CRP and PAD.
The research was done using a nested, case-controlled design, studying 144 healthy males
between the ages of 40-84 who were already participating in another study utilizing aspirin and
beta-carotene (Ridker et al., 2012). Data was collected using baseline CRP values, self-report
surveys and follow-up visit assessment data for a 60 month period. The results showed that
participants with a significantly increased baseline CRP level were more likely to develop PAD
than those they were matched with in the control group (Ridker et al., 2012). These results could
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have been skewed by inaccuracy of self-report surveys and inconsistency of follow-up
appointments by the participants. Not including all participants could lead to a stronger
perceived stronger correlation between elevated CRP levels and PAD.
The results of this study can be used by nurses to help educate and care for patients that
have elevated CRP levels. When administering pharmacotherapy for pain, a nurse can be sure to
include a non-steroidal anti-inflammatory if the client has an elevated baseline CRP level. As
the results from the study show, decreasing systemic inflammation also decreases a client’s risk
for developing PAD and further complications. Ridker and colleagues used only male
participants in their study, if a nurse were caring for a female patient it can be hypothesized that
there would be a more pronounced positive correlation. Women have smaller vasculature making
the effects of systemic inflammation and PAD more emphasized than in men. Further research
on this topic should be done to gain information on other patient populations such as women,
various races and socioeconomic
When developing a plan of care for a client with PAD one of the following nursing
diagnoses could be used; ineffective peripheral tissue perfusion r/t disease process, chronic pain:
intermittent claudication r/t ischemia or risk for peripheral neurovascular dysfunction: risk
factor: possible vascular obstruction. For a plan of care that focuses tissue perfusion, the patient
will demonstrate adequate tissue perfusion as evidenced by palpable pedal pulses every eight
hours for the duration of their inpatient stay. To help the patient achieve this outcome the nurse
will assess peripheral tissue perfusion every four hours each shift. The nurse will also encourage
use of compression devices and stockings each shift.
Educating patients is one of the most important things a nurse can do to have a long
standing effect on a patient’s health. Knowing factors that place patients at increased risk for
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developing disease is vital information that allows nurses to properly educate patients on lifestyle
changes. In the future, more research should be done to provide education on ways to help
patients at increased risk for developing PAD, decreasing their chances of getting the disease.
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References
Ridker, P., Cushman, M., Stampfer, M., Tracy, R., & Hennekens, C. (1998). Plasma
Concentration of c-reactive protein and isk of developing peripheral vascular disease.
Circulation Journal of the American Heart Association, 425-428.
doi:10.1161/01.CIR.97.5.425
Ladwig, G., & Ackley, B. (2014). Mosby's Guide to Nursing Diagnosis (Fourth ed.). Maryland
Heights, MD: Elsevier Saunders.