(Circulation. 1999;100:1148-1150.)
© 1999 American Heart Association, Inc.
Editorial |
Novel Inflammatory Markers of Coronary Risk
Theory Versus Practice
From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
Correspondence to Peter Libby, MD, Brigham and Women's Hospital, 221 Longwood Ave, LMRC 307, Boston, MA 02115. E-mail plibby@rics.bwh.harvard.edu
Key Words: Editorials • atherosclerosis • risk factors • inflammation • cytokines • interleukins
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Introduction |
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For practitioners committed to coronary risk reduction, recent clinical trial data pose a considerable challenge. Specifically, in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS), a primary prevention trial,1 treatment with lovastatin among an apparently healthy group of individuals without traditional coronary risk factors resulted in significant reductions in future cardiovascular events. Application of the results of that trial and of the West of Scotland primary prevention trial of pravastatin2 suggests that tens of millions of Americans without manifest atherosclerosis could benefit from lipid-lowering therapy.
Such a blanket approach, however, may be unwise from medical as well as economic perspectives. Unnecessary exposure to pharmacological agents, even those as safe as the statins, will ultimately subject some asymptomatic and low-risk individuals to unwanted side effects. Furthermore, economic constraints dictate that primary prevention strategies with even modest cost must be limited to those individuals who are likely to gain the greatest benefit. Even when an inexpensive preventive therapy such as low-dose aspirin is proven effective,3 behavioral barriers on the parts of both physicians and patients must be overcome if long-term compliance is to be achieved. All of these considerations highlight the need for better methods to stratify risk of atherosclerotic events in apparently healthy populations.
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New Approaches to Coronary Risk Assessment |
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Clinical strategies designed to improve risk prediction have taken several forms. Imaging techniques including carotid ultrasound, MRI, and electron beam computed tomography (EBCT) all hold promise for identifying "vulnerable plaques" and detecting silent atheroma. However, prospective studies demonstrating the clinical utility of these approaches are limited. For
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