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C-reactive protein and other inflammatory risk markers in acute coronary syndromes
1Center for Cardiovascular Disease Prevention, the Leducq Center for Cardiovascular Research, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Insights
Inflammation markers like C-reactive protein (CRP) help predict cardiovascular risk, especially in acute coronary syndromes (ACS) patients. Elevated CRP indicates higher risk and may guide treatment decisions for better outcomes.
Area of Science:
- Cardiology
- Inflammation Biology
Background:
- Myocyte necrosis markers (troponin, CK-MB) are key for acute coronary syndrome (ACS) risk stratification.
- Some ACS patients without necrosis evidence face high recurrent ischemic event risk.
- Inflammatory processes significantly impact plaque stability and cardiovascular events.
Purpose of the Study:
- To evaluate the role of plasma inflammation markers in improving cardiovascular risk stratification.
- To determine if inflammatory markers can identify high-risk patients, including those with troponin-negative ACS.
- To assess the clinical utility of novel inflammatory markers beyond traditional necrosis markers.
Main Methods:
- Review of studies investigating plasma inflammatory markers (CRP, IL-6, Lp-PLA2, MPO, PAPP-A) in cardiovascular risk assessment.
- Analysis of data from patients presenting with ACS, including troponin-negative cases.
- Evaluation of marker performance in diverse populations: healthy individuals, elective revascularization patients, and ACS patients.
Main Results:
- C-reactive protein (CRP) is a robust predictor of cardiovascular risk across various patient groups.
- Elevated CRP levels predict future risk even in troponin-negative ACS patients.
- Interleukin-6 (IL-6) and other inflammatory markers show promise in predicting vascular instability and guiding treatment strategies.
Conclusions:
- Inflammatory markers, particularly CRP, offer valuable adjuncts to traditional necrosis markers for cardiovascular risk stratification.
- Elevated CRP may identify patients who benefit most from interventions like lifestyle changes and therapies (aspirin, statins).
- Further investigation into novel inflammatory markers like IL-6 could refine early invasive strategy decisions in ACS.
Abstract:
Markers of myocyte necrosis such as cardiac troponin or creatine kinase-myocardial band are invaluable tools for risk stratification among patients presenting with acute coronary syndromes (ACS). Nonetheless, many patients without any evidence of myocyte necrosis may be at high risk for recurrent ischemic events. In consideration of the important role that inflammatory processes play in determining plaque stability, recent work has focused on whether plasma markers of inflammation may help improve risk stratification. Of these markers, C-reactive protein (CRP) has been the most widely studied, and there is now robust evidence that CRP is a strong predictor of cardiovascular risk among apparently healthy individuals, patients undergoing elective revascularization procedures, and patients presenting with ACS. Moreover, even among patients with troponin-negative ACS, elevated levels of CRP are predictive of future risk. Other, more upstream markers of the inflammatory cascade, such as interleukin (IL)-6, have also been found to be predictive of recurrent vascular instability. A recent report from the second FRagmin during InStability in Coronary artery disease trial investigators suggests that elevated levels of an inflammatory marker such as IL-6 may indicate which patients may benefit most from an early invasive strategy. Other inflammatory markers currently under investigation include lipoprotein-associated phospholipase A(2), myeloperoxidase, and pregnancy-associated plasma protein A. Of all these novel markers, CRP appears to meet most of the criteria required for potential clinical application. Furthermore, the benefits of lifestyle modification and drug therapy with aspirin or statins may be most marked among those with elevated CRP levels.