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Published on: February 20, 2019
Predicting risk and treatment benefit in atherosclerosis: the role of C-reactive protein
1Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Robert-Koch Strasse 8, D-89081 Ulm, Germany. wolfgang.koenig@medizin.uni-ulm.de
Insights
Measuring C-reactive protein (CRP) identifies individuals at high risk for heart attack and stroke. This inflammation biomarker can improve cardiovascular risk prediction and guide statin therapy, even for those without high cholesterol.
Area of Science:
- Cardiovascular Medicine
- Inflammation Biology
- Biomarker Discovery
Background:
- Atherosclerosis progression involves inflammatory mechanisms.
- Inflammatory biomarkers aid in identifying future vascular risk.
- C-reactive protein (CRP) is a key hepatic acute-phase reactant.
Purpose of the Study:
- To evaluate C-reactive protein (CRP) as a predictor of cardiovascular events.
- To assess the utility of CRP in enhancing global risk prediction.
- To explore the role of CRP in identifying individuals who may benefit from statin therapy.
Main Methods:
- Analysis of observational studies and data from large statin trials.
- Measurement of inflammatory biomarkers, specifically CRP.
- Comparison of CRP screening with standard lipid screening for risk prediction.
Main Results:
- CRP is a strong predictor of future myocardial infarction and stroke.
- Adding CRP to lipid screening improves risk prediction across cholesterol levels.
- Statins demonstrate beneficial effects on plaque inflammation, stability, and CRP levels.
Conclusions:
- CRP screening can identify individuals at high risk for cardiovascular events, including those without hyperlipidemia.
- CRP testing may guide targeted preventive interventions and statin therapy.
- Further prospective trials are needed to confirm CRP's role in risk stratification.
Abstract:
Inflammatory mechanisms play a prominent role in mediating all stages of atherosclerosis, and measurement of inflammatory biomarkers provides a method for detecting individuals at future vascular risk. Evidence from observational studies indicates that the hepatic acute-phase reactant, C-reactive protein (CRP), is the strongest predictor of future myocardial infarction and stroke. The addition of CRP to standard lipid screening may improve global risk prediction among those with high as well as low cholesterol. Statins have been shown to have beneficial effects on plaque inflammation, stability and CRP levels, in addition to their lipid-lowering effects. Data from two large statin trials suggest that testing for CRP may identify many individuals without hyperlipidaemia who are at high risk for future cardiovascular events and who may benefit from statin therapy. If confirmed in ongoing large-scale prospective trials, screening for inflammation using CRP as a biomarker could prove an important adjunctive method for identifying individuals at increased risk who would benefit most from targeted preventive interventions.
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