7ДЄMI triggers an acute phase response resulting in a rise of circulating CRP levels, which correlates with infarct size. 5 Even after correction for these risk factors, high-normal CRP levels still predict an increased risk for development of symptomatic peripheral arterial disease 37 and the occurrence of coronary events in both stable 19 and unstable 18 19 angina pectoris and even in apparently healthy persons. In cardiovascular disease without myocardial necrosis, plasma CRP correlates with the extent and severity of atherosclerosis 36 37 and with hemostatic, lipid, and infectious risk factors for cardiovascular disease. This explains why circulating CRP levels associated with increased risk or worse course vary from cutoff points of 0.3 mg/dL in unstable angina 18 35 to 20 mg/dL in AMI. In contrast, in the former the acute phase response is not triggered (at least not by myocardial necrosis) and baseline levels of circulating CRP are studied. In the latter situation the acute phase response is triggered, at least in part, by myocardial necrosis, and variations in postinfarct rise of circulating CRP are analyzed. Regarding associations between circulating CRP and cardiovascular disease (see Table 1 ), diseases without (atherosclerosis and stable and unstable angina) or with myocardial tissue damage (AMI) should be distinguished. 27 28 Here we review studies showing associations between CRP and cardiovascular disease and discuss possible explanations for these associations. 7 Finally, CRP can be found localized in inflamed tissues, 25 including atherosclerotic vessels 26 and infarcted myocardium. 21 22 23 24 Second, CRP is a cardiovascular risk factor even after correction for other risk factors. First, chronic infections that cause a rise in circulating CRP also yield a higher risk for cardiovascular disease. However, several arguments are against this explanation that increased plasma levels of CRP are merely an epiphenomenon. The link between CRP and cardiovascular disease is thought to be indirect in that circulating CRP only reflects the extent of the acute phase reaction in response to nonspecific stimuli such as confounding risk factors, atherosclerosis, vascular injury, ischemia, and necrosis. In this respect, the acute phase reactant C-reactive protein (CRP) is of special interest: Baseline levels of CRP in apparently healthy persons or patients with stable angina pectoris constitute an independent risk factor for cardiovascular events, 4 5 6 7 8 whereas the rise in CRP after acute myocardial infarction (AMI) 9 10 11 12 13 14 15 16 or during unstable angina pectoris 17 18 19 20 correlates with outcome.

1 2 3 Some inflammatory or hemostatic markers actually constitute cardiovascular risk factors. Recent studies provide evidence that inflammation plays a role in the pathogenesis of cardiovascular disease. Unraveling the molecular background of this association may provide new directions for prevention of cardiovascular events.

However, because CRP localizes in infarcted myocardium (with colocalization of activated complement), we hypothesize that CRP may directly interact with atherosclerotic vessels or ischemic myocardium by activation of the complement system, thereby promoting inflammation and thrombosis.Д¬onclusions-CRP constitutes an independent cardiovascular risk factor. This link between CRP and cardiovascular disease has been considered to reflect the response of the body to the inflammatory reactions in the atherosclerotic (coronary) vessels and adjacent myocardium. High CRP responses after acute myocardial infarction indicate an unfavorable outcome, even after correction for other risk factors. CRP levels within the upper quartile/quintile of the normal range constitute an increased risk for cardiovascular events, both in apparently healthy persons and in persons with preexisting angina pectoris. Methods and Results-By reviewing available studies, we discuss explanations for the associations between CRP and cardiovascular disease. How CRP as a risk factor is involved in cardiovascular disease is still unclear. Customer Service and Ordering InformationД«ackground-Circulating levels of C-reactive protein (CRP) may constitute an independent risk factor for cardiovascular disease.Journal of the American Heart Association (JAHA).Stroke: Vascular and Interventional Neurology.Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).

Risk pc game 1996