Abstract
The genesis of an atherosclerotic plaque depends on interplay of cellular components of the immune system such as monocytes, cytokines, and cell adhesion molecules with lipids, platelets and endothelial cells. Thus, inflammation may play a pivotal role in the propagation of coronary artery disease. Several reports have linked inflammation and cardiovascular risk, particularly a novel acute inflammatory peptide, C-reactive protein (CRP), with future risk of coronary events independent of the traditional coronary artery disease risk factors. To this end, many studies suggest that CRP may be used as a marker of sub-clinical atherosclerosis and cardiovascular risk. Specifically, CRP has been positively linked to future cardiovascular events in healthy women, healthy men, elderly patients, and high-risk individuals. In addition, reports have shown associations between CRP and peripheral vascular disease and stroke. Furthermore, preliminary data suggest that the relative efficacy of secondary preventive therapies such as statin drugs and aspirin may depend on the individual patient's baseline CRP level.
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References and Recommended Reading
Ross T: The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature 1993, 362:801–809.
Libby, P: Molecular bases of the acute coronary syndromes. Circulation 1995, 91:2844–2850.
Ridker PM, Buring JE, Shih J, et al.: A prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 1998, 98:731–733.
• • Ridker PM, Cushman M, Stampfer MJ, et al.: Inflammation, aspirin and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997, 336:973–979.
Prospective study demonstrating CRP as a risk factor for MI and stroke, and reporting an interaction between aspirin and inflammation
Ridker PM, Glynn RJ, Hennekens CH: C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction. Circulation 1998, 97:2007–2011.
Kuller LH, Tracy RP, Shaten J, Meilahn EN, for the MRFIT Research Group: Relationship of C-reactive protein and coronary heart disease in the MRFIT nested case-control study. Am J Epidemiol 1996, 144:537–547.
Koenig W, Sund M, Frolich M, et al.: C-reactive protein, a sensitive marker for inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men. Results from the MONICA-Augsberg Cohort Study 1984-1992. Circulation 1999, 99:237–242.
Tracy RP, Lemaitre RN, Psaty BM, et al.: Relationship of C-reactive protein to risk of cardiovascular disease in the elderly. Results from the Cardiovascular Health Study and the Rural Health Promotion Project. Arteriosclerosis Thromb Vascular Biol 1997, 17:1121–1127.
Thompson SG, Kienast J, Pyke SDM, et al., for the European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group: Hemostatic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris. N Engl J Med 1995, 332:635–641.
Ridker PM, Cushman M, Stampfer MJ, et al.: Plasma concentration of C-reactive protein and risk of developing peripheral vascular disease. Circulation 1998, 425–428.
Ridker PM, Rifai N, Pfeffer MA, et al., for the Cholesterol and Recurrent Events (CARE) Investigators: Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Circulation 1998, 98:839–844.
Tillet WS, Francis T: Serological reactions in pneumonia with a non-protein somatic fraction of pneumococcus. J Exp Med 1930, 52:561–571.
Young B, Gleeson M, Cripps A: C-reactive protein: a critical review. Pathology 1991, 23:118–124.
Macy EM, Hayes TE, Tracy RP: Variability in the measurement of C-reactive protein in healthy subjects: implications for reference interval and epidemiological applications. Clin Chem 1997, 43:52–58.
Liuzzo G, Biasucci LM, Gallimore JR, et al.: The prognostic value of C-reactive protein and serum amyloid protein in severe unstable angina. N Engl J Med 1994, 331:417–424.
Haverkate F, Thompson SG, Pyke SDM, et al., for the European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group: Production of C-reactive protein and risk of coronary events in stable and unstable angina. Lancet 1997, 349:462–466.
Witteman JCM, Grobusch KK, Grobbee DE, Hofman A: Markers of inflammation in an elderly population: abstract of the 39th Annual Conference on Cardiovascular Disease Epidemiology and Prevention, 1999. Circulation 1999, 99:1108.
Cushman M, Meilahn EN, Psaty BM et al.: Hormone replacement therapy, inflammation, and hemostasis in elderly women. Arteriosclerosis Thromb Vascular Biol 1999, in press.
Ridker RM, Hennekens CH, Rifai N, et al.: Hormone replacement therapy and increased plasma concentration of C-reactive protein. Circulation 1999, in press.
Hulley S, Grady D, Bush T, et al., for the Heart and Estrogen/progestin Replacement Study (HERS) Research Group: Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 1998, 280:605–613.
Curb JD, Abbott RD, Rodriguez BL, et al.: The relationship of C-reactive protein to the incidence of thromboembolic stroke: abstract of the 39th Annual Conference on Cardiovascular Disease Epidemiology and Prevention 1999. Circulation 1999. 99:1108.
• Morrow DA, Rifai N, Antman E, et al.: C-reactive protein is a potent predictor of mortality independently of and in combination with troponin T in acute coronary syndromes: A TIMI 11A Substudy. JACC 1998, 31:1460–1465.
A substudy of TIMI 11A showing that elevated CRP at presentation in patients with angina or non-Q-wave myocardial infarction predicts two week mortality and that CRP is complementary to rapid troponin T assay in mortality risk stratification
Toss H, Lindahl B, Siegahn A, Wallentin L: Prognostic influence of fibrinogen and C-reactive protein levels in unstable coronary artery disease. FRISC Study Group. Circulation 1997, 96:4204–4210.
Ferreiros E, Boissonnet C, Pizarro R, et al.: Elevated C-reactive protein at discharge is a strong predictor of 90 day outcome in unstable angina. [Abstract]. Circulation 1998, 98:1–193.
Biasucci L, Liuzzo G, Grillo R, et al.: Elevated levels of C-reactive protein at discharge in patients with unstable angina predict recurrent instability. Circulation 1999, 99:855–860.
Benamer H, Steg PG, Benessiano J, et al.: Comparison of prognostic value of C-reactive protein and troponin I in patients with unstable angina. Am J Cardiology 1998, 82:845–850.
Oltrona L, Ardissino D, Merlini PA, et al.: C-reactive protein elevation and early outcome in patients with unstable angina pectoris. Am J Cardiology 1997, 80:1002–1006.
Pietila KO, Harmoinen AP, Jokiniitty J, Pasternack AI: Serum C-reactive protein concentration in acute myocardial infarction and its relationship to mortality during 24 months of follow-up in patients under thrombolytic treatment. Eur Heart J 1996, 17:1345–1349.
Anzai T, Yoshikawa T, Shiraki H, et al.: C-reactive protein as a predictor of infarct expansion and cardiac rupture after a first Q-wave acute myocardial infarction. Circulation 1997, 96:781–784.
Ridker PM, Kundsin RB, Stampfer MJ, et al.: A prospective study of chlamydia pneumoniae IgG seropositivity and future risk of myocardial infarction. Circulation 1999, 99:1161–1164.
Ridker PM, Hennekens CH, Stampfer MJ, Wang F: Prospective study of herpes simplex virus, cytomegalovirus and the risk of future myocardial infarction and stroke. Circulation 1998, 98:2796–2799.
Ridker PM, Hennekens CH, Roitman-Johnson B, et al.: Plasma concentration of soluble intercellular adhesion molecule 1 and risks of future myocardial infarction in apparently healthy men. Lancet 1998, 351:88–92.
Ridker PM: Intercellular adhesion molecule (ICAM-1) and the risks of developing atherosclerotic disease. Eur Heart J 1998, 19:1119–1121.
• Hwang SJ, Ballantyne CM, Sharett AR, et al.: Circulating adhesion molecules VCAM-1, ICAM-1, and E-selectin in carotid atherosclerosis and incident coronary heart disease cases: the Atherosclerosis Risk In Communities (ARIC)study. Circulation 1997, 96:4219–4225. Cohort study of American men and women demonstrating that plasma concentrations of adhesion molecules ICAM-1 and E-selectin are associated with increased prevalence of coronary heart disease and carotid atherosclerosis and also predicted risk of subsequent coronary heart disease at 5-year follow-up
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Albert, M.A., Ridker, P.M. The role of C-reactive protein in cardiovascular disease risk. Curr Cardiol Rep 1, 99–104 (1999). https://doi.org/10.1007/s11886-999-0066-0
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DOI: https://doi.org/10.1007/s11886-999-0066-0