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Inflammation, the metabolic syndrome and cardiovascular risk
1University of Vermont College of Medicine, Burlington, Vermont, USA.
Insights
Cardiovascular disease (CVD) and atherosclerosis involve a microinflammatory component. Inflammatory markers like C-reactive protein (CRP) effectively predict CVD risk across diverse populations.
Area of Science:
- Cardiovascular Medicine
- Immunology
- Metabolic Disorders
Background:
- Cardiovascular disease (CVD) and atherosclerosis are increasingly understood to have a microinflammatory basis.
- Conditions predisposing to CVD, such as metabolic syndrome and type 2 diabetes, exhibit a significant inflammatory component.
- Low-grade inflammation, indicated by inflammatory markers in the upper normal range, is associated with CVD risk.
Purpose of the Study:
- To explore the complex relationship between inflammation, atherosclerosis, metabolic syndrome, and CVD.
- To highlight the utility of single inflammatory markers in assessing CVD risk.
- To discuss the implications of inflammation in chronic diseases of aging and their treatment.
Main Methods:
- Review of current scientific literature on inflammation and cardiovascular disease.
- Analysis of the role of inflammatory markers such as C-reactive protein (CRP) and fibrinogen.
- Examination of the influence of factors like genetic variation, environmental exposures, and adipose tissue mass on inflammatory responses.
Main Results:
- Inflammatory markers, particularly CRP, demonstrate strong predictive value for CVD risk, including myocardial infarction and vulnerable plaque.
- Inflammation is linked to numerous chronic diseases of aging and general metabolism.
- Visceral adiposity significantly impacts inflammation status.
Conclusions:
- The relationship between atherosclerosis, metabolic syndrome, and inflammation is exceptionally complex.
- Inflammatory markers provide valuable insights into CVD risk prediction.
- Therapeutic strategies targeting atherosclerosis may exert effects by modulating inflammation, with implications for managing chronic age-related diseases.
Abstract:
Over the past ten years it has become clear that cardiovascular disease (CVD) and atherosclerosis have a 'microinflammatory' component and are often associated with low levels of inflammatory markers that are in the upper part of the 'normal' range. In particular, diseases that predispose to CVD, such as the metabolic syndrome and type 2 diabetes, appear to have a very strong inflammatory component. While the inflammatory process is very complicated, single measures, such as C-reactive protein (CRP) or fibrinogen, have clear benefits as they summarise many different parts of the inflammatory process and are easy to apply. However, it is important to remember that the process of inflammation includes coagulation, fibrinolysis, complement activation, antioxidation, immune response and hormonal regulation through the hypothalamic-pituitary-adrenal axis. Furthermore, genetic variation, differences in exposure to environmental influences and the mass of inflammation-producing tissue (e.g. adipose tissue) can all influence responses. Thus, the relationship between atherosclerosis, the metabolic syndrome and inflammation is extraordinarily complex. Inflammatory markers such as CRP exhibit strong CVD-risk prediction that is consistent across sexes and a number of different populations. They reflect risk not only for 'vulnerable plaque' and myocardial infarction (MI) but also for other cardiovascular diseases. In fact, inflammation is associated with several, if not all, of the chronic diseases of old age, and it is now clear that there are important links between inflammation and general metabolism. For instance, visceral adiposity exerts a major influence on inflammation status. Medications that affect atherosclerosis appear to do so at least in part by influencing inflammation (for instance, the emerging pleiotropic effects of statins), and this has far-reaching ramifications for chronic diseases of old age and their treatment.