Inflammation, high-sensitivity C-reactive protein, and vascular protection.
Year: 2010
Type: article
Abstract: As described in the 2009 Canadian Cardiovascular Society Guidelines for the Diagnosis and Treatment of Dyslipidemia and Prevention of Cardiovascular Disease in the Adult, the inflammatory biomarker high-sensitivity C-reactive protein (hs-CRP) is now recognized as a major cardiovascular risk factor and as a secondary target for statin therapy.1 This important change in prevention guidelines reflects data from the recent JUPITER trial of apparently healthy men and women with hs-CRP levels greater than 2 mg/L who did not otherwise qualify for statin therapy because of “low” absolute risk, as calculated by traditional risk algorithms and native low-density-lipoprotein cholesterol levels below 130 mg/dL. Nonetheless, in comparison with the administration of a placebo, the JUPITER investigators' allocation of such patients to 20 mg of rosuvastatin resulted in a 44% reduction in the primary trial endpoint of major vascular events (P <0.00001), a 54% reduction in myocardial infarction (P=0.0002), a 48% reduction in stroke (P=0.002), a 46% reduction in the need for angioplasty or bypass surgery (P <0.0001), and a 20% reduction in all-cause death (P=0.02).2 These risk reductions were observed at all levels of Framingham Risk—among 6,091 persons in JUPITER with elevated hs-CRP but Framingham Risk Scores of 5% to 10%, a 45% reduction in major vascular events was observed (hazard ratio, 0.55; 95% confidence interval, 0.36–0.84; P=0.005), whereas among 7,340 persons with elevated hs-CRP but Framingham Risk Scores of 11% to 20%, a 49% reduction in major vascular events was observed (hazard ratio, 0.51; 95% confidence interval, 0.39–0.68; P=0.0001). On the basis of these and other data, the 2009 National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines included and endorsed the use of hs-CRP as a novel means by which to identify individuals who are at high risk for vascular disease.3
Source: PubMed Central
Author: Paul M Ridker
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W168483038