[Atherosclerosis and inflammation: the role of C-reactive protein]

C-reactive protein (CRP) is an acute phase protein, the serum concentration of which can increase up to a 1000-fold after the onset of a stimulus. It plays a role in the aspecific immune response to bacteria and fungi and the clearance of apoptotic cell material. Inflammation plays an important role in the aetiology and pathogenesis of atherosclerosis and plaque formation. Approximately fifty percent of acute coronary syndromes are the consequence of unstable plaques rupturing, followed by thrombus formation. A characteristic of these unstable plaques is an increase in inflammatory cells (macrophages and T lymphocytes). The serum concentration of CRP might reflect the amount of inflammation within atherosclerotic plaques and thus might provide an indirect measurement of the instability of the plaques. CRP could therefore have a predictive value for the occurrence of plaque rupture. Furthermore, there are indications that CRP itself is active in the inflammatory process. Prospective studies have shown that so-called high-sensitivity CRP (hsCRP) measurements could be used as a tool for determining the risk for acute coronary syndromes. The inflammation-inhibiting characteristics of statins and acetylsalicylic acid (especially the reduction of the hsCRP level) might contribute to reducing the risk of plaque rupture.