Circulation. 1998;97:2000-2002
(Circulation. 1998;97:2000-2002.)
© 1998 American Heart Association, Inc.
Inflammation in Cardiovascular Disease
Cart, Horse, or Both?
Russell P. Tracy, PhD
Key Words: Editorials • C-reactive protein • risk factors • cholesterol • coagulation • fibrinolysis
In
this issue of Circulation, Ridker and
colleagues1 discuss the incremental value of CRP
as a predictor of future CVD events. Their conclusion is that CRP is at
least additive to HDL and total cholesterol with respect to
risk prediction. In fact, there is some evidence that lipids and CRP
are better predictors jointly than would be expected by adding up their
individual predictive powers. CRP appeared to predict events in those
at low risk on the basis of lipids, and CRP-lipid relationships to
events were minimally altered by adjustment for other known CVD risk
factors. These findings have important implications for CVD risk
assessment and risk management.
CRP is an acute-phase reactant, the levels of which increase
dramatically (100-fold or more) in response to severe bacterial
infection, physical trauma, and other inflammatory
conditions.2 Several roles have been postulated
for CRP, including that of an opsonin, promoting the phagocytic uptake
of invading microorganisms, and that of a procoagulant, promoting the
expression of tissue factor on the monocyte surface. As a marker of
inflammation, CRP is unique among the major plasma proteins in the fold
increase that is observed and in that its levels appear to be
unaffected by hormones and anti-inflammatory drugs but are regulated
primarily by the proinflammatory cytokines, especially
IL-6.2 3 Traditionally, 10 mg/L has been used as
the cut point to signify clinically important levels, with values in
the healthy reference range at or below the lower limit of sensitivity
of most assays.
Recently, elevated levels of . . . [Full Text of this Article]
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