C-Reactive Protein in Atherosclerosis-More than a Biomarker, but not Just a Culprit

C-reactive protein (CRP) is a pentraxin that is mainly synthesized in the liver in response to inflammatory cytokines. It exists in two functionally and structurally distinct isoforms. The first is a highly pro-inflammatory and mostly tissue-bound monomeric isoform (mCRP). The second is circulating pentameric CRP (pCRP), which also serves as a substrate for the formation of mCRP. CRP is elevated during inflammatory conditions and is associated with a higher risk of cardiovascular disease. The aim of this review is to examine the current state of knowledge regarding the role of these two distinct CRP isoforms on atherogenesis. This should allow further evaluation of CRP as a potential therapeutic target for atherosclerosis. While it seems clear that CRP should be used as a therapeutic target for atherosclerosis and cardiovascular disease, questions remain about how this can be achieved. Current data suggests that CRP is more than just a biomarker of atherosclerosis and cardiovascular disease. Indeed, recent evidence shows that mCRP in particular is strongly atherogenic, whereas pCRP may be partially protective against atherogenesis. Thus, further investigation is needed to determine how the two CRP isoforms contribute to atherogenesis and the development of cardiovascular disease.