C-reactive protein in cardiovascular risk evaluation

Inflammation plays a central role in the initiation, progression and destabilization of atheroma. In an attempt to improve global cardiovascular risk assessment considerable research has focused on inflammatory markers, particularly high sensitive C-reactive protein (hs-CRP). It has been reported that hs-CRP levels more than 3 mg/L identify increased risk of initial cardiovascular events in healthy individuals and also increased risk of adverse events in patients with stable and unstable angina, acute myocardial infarction, and in patients undergoing coronary revascularization procedures. Furthermore, several pharmacologic (eg. aspirin, statins, tienopiridins) and lifestyle interventions (eg. weight loss, smoking cessation, regular exercise) known to reduce cardiovascular events rates have also been shown to lower levels of hs-CRP. Therefore, hs-CRP levels may also prove useful in targeting therapy for primary and secondary prevention. This review discusses the role of hs-CRP in the pathogenesis of atherosclerosis and its application in every day clinical practice, including the role of hs-CRP in identification of high-risk individuals, monitoring of the coronary artery disease activity, and assessment of therapeutic effect on the inflamatory component of the cardiovascular process.