Inflammation in plaque rupture: an active participant or an invited guest?

Numerous reports have established the association of inflammation with acute coronary events. Data have been presented that suggest that elevated levels of CRP indicate heightened risk of future MI and stroke. Thus CRP measurement is both predictive and prognostic of cardiovascular and cerebrovascular events. Is inflammation merely a marker, an invited guest so to speak, or is inflammation an active participant that influences the process of plaque rupture and thrombus formation? The beneficial effects of aspirin in reducing the risks of a first MI and stroke are directly related to high plasma concentrations of CRP, whereas small, nonsignificant reductions in risk occurred among patients with low or normal CRP levels. Thus inflammation is not only an uninvited guest but is actually an aggressive participant in the destabilization of the atheromatous endothelial plaque.