High-sensitivity C-reactive protein, inflammation, and cardiovascular risk: from concept to clinical practice to clinical benefit.
Advances in vascular biology have shown that inflammation plays an integral role in the development of cardiovascular disease. Extensive study of high-sensitivity C-reactive protein (hs-CRP) has demonstrated that this measure of inflammation predicts cardiovascular risk not reflected by traditional risk factors, adds prognostic information to traditional risk assessment, and predicts long-term cardiovascular risk in individuals with no prior evidence of cardiovascular disease. Patients with elevated hs-CRP levels in the absence of elevated cholesterol appear to derive preventive benefit from statin therapy that is similar in magnitude to that in patients with elevated cholesterol. The large-scale Justification for the Use of statins in Primary prevention: an Intervention Trial Evaluating Rosvastatin (JUPITER) trial represents a critical study to determine the utility of a strategy for targeting statin therapy to prevent incident cardiovascular disease in patients at increased cardiovascular risk on the basis of elevated hs-CRP who would not be considered candidates for therapy on the basis of hypercholesterolemia or traditional risk assessment. Inclusion of hs-CRP measurement in risk screening and use of this information to guide preventive therapy could result in a marked improvement in prevention of cardiovascular morbidity and mortality.
Ridker
Paul M
PM
Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Boston, Mass 02215, USA. pridker@partners.org
D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D008078:Cholesterol, LDL / Q000097:blood; D002986:Clinical Trials as Topic; D006801:Humans; D007249:Inflammation / Q000097:blood*; D008055:Lipids / Q000097:blood; D024821:Metabolic Syndrome / Q000150:complications; D009203:Myocardial Infarction / Q000209:etiology; D012306:Risk; D012307:Risk Factors; D020521:Stroke / Q000209:etiology
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D008055:Lipids; D002097:C-Reactive Protein