Identifying patients at risk of coronary vascular disease: the potential role of inflammatory markers

Inflammation is intimately involved in the pathogenesis of cardiovascular disease (CVD). The measurement of inflammatory markers may be a potent method for identifying individuals with increased inflammation at risk of future cardiovascular events. High-sensitivity C-reactive protein (hs-CRP), one marker of inflammation, is a strong independent predictor of CVD and can be used to identify individuals at increased risk who would otherwise be missed if standard lipid measurements only were used. Furthermore, CRP may actively participate in the pathogenic progression of atherosclerotic disease by activating complement, inducing synthesis of tissue factor, influencing nitric oxide levels, and enhancing foam cell uptake of low-density lipoprotein cholesterol. Simple, inexpensive methods for measuring hs-CRP are commercially available, making the measurement of CRP Levels feasible in clinical settings. Together, these data suggest that the ability to accurately predict CVD risk may be significantly increased by including CRP measurements in risk assessment models. In addition, the identification of increased inflammation suggests that rational therapy should be applied and favours treatments with anti-inflammatory action. (C) 2004 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.