Circulation. 2004;109:2818-2825
doi: 10.1161/01.CIR.0000132467.45278.59
doi: 10.1161/01.CIR.0000132467.45278.59
(Circulation. 2004;109:2818-2825.)
© 2004 American Heart Association, Inc.
Reviews: Current Perspectives |
Should C-Reactive Protein Be Added to Metabolic Syndrome and to Assessment of Global Cardiovascular Risk?
From the Donald W. Reynolds Center for Cardiovascular Research (P.M.R., P.W.F.W.), Boston, Mass; Center for Cardiovascular Disease Prevention, Brigham and Women’s Hospital, Harvard Medical School (P.M.R.), Boston, Mass; Medical University of South Carolina (P.W.F.W.), Charleston, SC; Donald W. Reynolds Center for Cardiovascular Research (S.M.G.), Dallas, Tex; and Center for Human Nutrition and the Departments of Clinical Nutrition and Internal Medicine (S.M.G.), University of Texas Southwestern Medical Center, Dallas, Tex.
Correspondence to Dr Paul M Ridker, Center for Cardiovascular Disease Prevention, Brigham and Women’s Hospital, 900 Commonwealth Ave East, Boston, MA 02215. E-mail pridker{at}partners.org
Abstract
Of novel risk factors for cardiovascular disease currently under investigation, high-sensitivity C-reactive protein (hsCRP) is the most promising. To date, more than 20 prospective epidemiologic studies have demonstrated that hsCRP independently predicts vascular risk, 6 cohort studies have confirmed that hsCRP evaluation adds prognostic information beyond that available from the Framingham Risk Score, and 8 cohort studies have demonstrated additive prognostic value at all levels of metabolic syndrome or in the prediction of type 2 diabetes. In contrast to several other biomarkers that also reflect biological aspects of inflammation, hypofibrinolysis, and insulin resistance, hsCRP measurement is inexpensive, standardized, widely available, and has a decade-to-decade variation similar to that of cholesterol. Given the consistency of prognostic data for hsCRP and the practicality of its use in outpatient clinical settings, we believe the time has come for a careful consideration of adding hsCRP as a clinical criterion for metabolic syndrome and for the creation of an hsCRP-modified coronary risk score useful for global risk prediction in both men and women. Toward this end, we believe experts in the fields of epidemiology, prevention, vascular biology, and clinical cardiology should be convened to begin discussing the merits of this proposal.
Key Words: inflammation • risk factors • prevention • diabetes mellitus • atherosclerosis
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