C-reactive protein, inflammation, and coronary risk: an update

The recognition that inflammation is closely related to atherothrombosis, diabetes, and the metabolic syndrome, represents an enormously important advance in medical science. The prevention community initially took a very cautious approach to recommending CRP measurements, in part because of the variable quality of assays; the advent of high sensitivity CRP measurements and the remarkable research output from Ridker's lab and many others, has demonstrated that this inflammatory marker can provide useful prognostic information, and has contributed a great deal to our understanding of pathobiology. Normal values have been established, and high sensitivity CRP assays are widely available; it is likely that CRP measurements will become increasingly used by physicians to assess vascular risk and potentially to guide therapy. Measurements of CRP in active clinical syndromes, such as coronary artery disease patients with vascular disease or congestive heart failure, would appear at this time to have little useful purpose outside of clinical research studies. We must remember that CRP is but one of many inflammatory markers; nevertheless, the database supporting CRP measurements is far greater than for any of the other markers, and the widely available hs-CRP assay makes it extremely attractive to pursue the conundrum of inflammation and athersclerosis with vigor.