This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bhatt, D. L. Articles by Topol, E. J. Search for Related Content PubMed PubMed Citation Articles by Bhatt, D. L. Articles by Topol, E. J. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Coronary Artery Disease Related Collections Secondary prevention Risk Factors Mechanism of atherosclerosis/growth factors

(Circulation. 2002;106:136.)
© 2002 American Heart Association, Inc.

Current Perspective

Need to Test the Arterial Inflammation Hypothesis

Deepak L. Bhatt, MD; Eric J. Topol, MD

From the Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.

Correspondence to Eric J. Topol, MD, 9500 Euclid Ave, Desk F25, Cleveland, OH 44195. E-mail topole@ccf.org

Key Words: arteries • inflammation • coronary disease

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Despite intensive basic and clinical investigation, coronary artery disease remains the principal cause of death and disability in the United States. In recent years, the appreciation of arterial inflammation as an important risk factor has had considerable implications for changing our approach to managing these patients.^1,2 Arterial inflammation has emerged as central to the progression of atherothrombosis.³ Of the markers of inflammation, the high-sensitivity C-reactive protein (CRP) is the most studied, with evidence that it may also play a direct pathogenic role in atherosclerotic lesion formation.^{4– 11} In the absence of active infection, measurements of CRP are reasonably reproducible, comparable to measurements of total cholesterol.^12,13 Additionally, elevated CRP appears to be a more potent risk factor than other mediators of inflammation, such as tumor necrosis factor-, interleukin-6, or serum amyloid A.^4,14 A group of pharmacotherapies that are currently available, such as aspirin, statins, angiotensin converting enzyme inhibitors (ACE-Is), thienopyridines, and peroxisome proliferator-activated receptor (PPAR) agonists have been shown, in addition to their other properties, to reduce CRP and/or arterial inflammation. Although it is clear that elevated CRP denotes increased risk and emerging evidence suggests that there are novel therapies that result in lowering of CRP, the most important unanswered question is whether suppression of inflammation and consequent lowering of CRP will translate into a decrease in clinical events.¹⁵ Surprisingly, despite the importance of the question, the "inflammation hypothesis" of intentional CRP suppression as compared with standard care has not yet been tested. Such a prospective study of patients with established . . . [Full Text of this Article]

This article has been cited by other articles:

				G. Montalescot, H. Drexler, R. Gallo, T. Pearson, M. Thoenes, and D. L. Bhatt Effect of irbesartan and enalapril in non-ST elevation acute coronary syndrome: results of the randomized, double-blind ARCHIPELAGO study Eur. Heart J., November 2, 2009; 30(22): 2733 - 2741. [Abstract] [Full Text] [PDF]

				A. S. Leon and U. G. Bronas Pathophysiology of Coronary Heart Disease and Biological Mechanisms for the Cardioprotective Effects of Regular Aerobic Exercise American Journal of Lifestyle Medicine, September 1, 2009; 3(5): 379 - 385. [Abstract] [PDF]

				R. Ramaraj Gender Differences Between High-Sensitivity C-Reactive Protein and Intima Media Thickness Progression Stroke, April 1, 2008; 39(4): e73 - e73. [Full Text] [PDF]

				K. K. Ray, C. P. Cannon, R. Cairns, D. A. Morrow, N. Rifai, A. J. Kirtane, C. H. McCabe, A. M. Skene, C. M. Gibson, P. M. Ridker, et al. Relationship Between Uncontrolled Risk Factors and C-Reactive Protein Levels in Patients Receiving Standard or Intensive Statin Therapy for Acute Coronary Syndromes in the PROVE IT-TIMI 22 Trial J. Am. Coll. Cardiol., October 18, 2005; 46(8): 1417 - 1424. [Abstract] [Full Text] [PDF]

				D. L. Bhatt and E. J. Topol Periprocedural Cardiac Enzyme Elevation Predicts Adverse Outcomes Circulation, August 9, 2005; 112(6): 906 - 922. [Full Text] [PDF]

				L. M. Biasucci CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: Clinical Use of Inflammatory Markers in Patients With Cardiovascular Diseases: A Background Paper Circulation, December 21, 2004; 110(25): e560 - e567. [Abstract] [Full Text] [PDF]

				S Kony, M Zureik, F Driss, C Neukirch, B Leynaert, and F Neukirch Association of bronchial hyperresponsiveness and lung function with C-reactive protein (CRP): a population based study Thorax, October 1, 2004; 59(10): 892 - 896. [Abstract] [Full Text] [PDF]

				R. Mills and D. L. Bhatt The yin and yang of arterial inflammation J. Am. Coll. Cardiol., July 7, 2004; 44(1): 50 - 52. [Full Text] [PDF]

				R. D. Brook, B. Franklin, W. Cascio, Y. Hong, G. Howard, M. Lipsett, R. Luepker, M. Mittleman, J. Samet, S. C. Smith Jr, et al. Air Pollution and Cardiovascular Disease: A Statement for Healthcare Professionals From the Expert Panel on Population and Prevention Science of the American Heart Association Circulation, June 1, 2004; 109(21): 2655 - 2671. [Abstract] [Full Text] [PDF]

				V. Panichi, U. Maggiore, D. Taccola, M. Migliori, G. M. Rizza, C. Consani, A. Bertini, S. Sposini, R. Perez-Garcia, P. Rindi, et al. Interleukin-6 is a stronger predictor of total and cardiovascular mortality than C-reactive protein in haemodialysis patients Nephrol. Dial. Transplant., May 1, 2004; 19(5): 1154 - 1160. [Abstract] [Full Text] [PDF]

				D. L. Brown, K. K. Desai, B. A. Vakili, C. Nouneh, H.-M. Lee, and L. M. Golub Clinical and Biochemical Results of the Metalloproteinase Inhibition with Subantimicrobial Doses of Doxycycline to Prevent Acute Coronary Syndromes (MIDAS) Pilot Trial Arterioscler Thromb Vasc Biol, April 1, 2004; 24(4): 733 - 738. [Abstract] [Full Text] [PDF]

				D. L. Bhatt Aspirin resistance: more than just a laboratory curiosity J. Am. Coll. Cardiol., March 17, 2004; 43(6): 1127 - 1129. [Full Text] [PDF]

				S. Verma, M. R. Buchanan, and T. J. Anderson Endothelial Function Testing as a Biomarker of Vascular Disease Circulation, October 28, 2003; 108(17): 2054 - 2059. [Full Text] [PDF]

				H S Gurm, D L Bhatt, A M Lincoff, J E Tcheng, D J Kereiakes, N S Kleiman, G Jia, and E J Topol Impact of preprocedural white blood cell count on long term mortality after percutaneous coronary intervention: insights from the EPIC, EPILOG, and EPISTENT trials Heart, October 1, 2003; 89(10): 1200 - 1204. [Abstract] [Full Text] [PDF]

				D. G. Hackam and S. S. Anand Emerging Risk Factors for Atherosclerotic Vascular Disease: A Critical Review of the Evidence JAMA, August 20, 2003; 290(7): 932 - 940. [Abstract] [Full Text] [PDF]

				D. A. Morrow and E. Braunwald Future of Biomarkers in Acute Coronary Syndromes: Moving Toward a Multimarker Strategy Circulation, July 22, 2003; 108(3): 250 - 252. [Full Text] [PDF]

				D. H. Gunawardana, R. L. Basser, I. D. Davis, J. Cebon, P. Mitchell, C. Underhill, T. J. Kilpatrick, K. Reardon, M. D. Green, P. Bardy, et al. A Phase I Study of Recombinant Human Leukemia Inhibitory Factor in Patients with Advanced Cancer Clin. Cancer Res., June 1, 2003; 9(6): 2056 - 2065. [Abstract] [Full Text] [PDF]

				C.-H. Wang, S.-H. Li, R. D. Weisel, P. W.M. Fedak, A. S. Dumont, P. Szmitko, R.-K. Li, D. A.G. Mickle, and S. Verma C-Reactive Protein Upregulates Angiotensin Type 1 Receptors in Vascular Smooth Muscle Circulation, April 8, 2003; 107(13): 1783 - 1790. [Abstract] [Full Text] [PDF]

				A. W. Chan, D. L. Bhatt, D. P. Chew, J. Reginelli, J. P. Schneider, E. J. Topol, and S. G. Ellis Relation of Inflammation and Benefit of Statins After Percutaneous Coronary Interventions Circulation, April 8, 2003; 107(13): 1750 - 1756. [Abstract] [Full Text] [PDF]

				J. Kennedy and A.M. Buchan Ever Decreasing Circles: Advances in Antiplatelet Therapy and Anticoagulation Stroke, February 1, 2003; 34(2): 348 - 350. [Full Text] [PDF]

				P. M Ridker Clinical Application of C-Reactive Protein for Cardiovascular Disease Detection and Prevention Circulation, January 28, 2003; 107(3): 363 - 369. [Full Text] [PDF]

				R. K. Yarlagadda and W. E. Boden Cardioprotective effects of an early invasive strategy for non-ST-segment elevationacute coronary syndromes: Are we all becoming "interventional" cardiologists? J. Am. Coll. Cardiol., December 4, 2002; 40(11): 1915 - 1918. [Full Text] [PDF]

				L. Mosca C-Reactive Protein -- To Screen or Not to Screen? N. Engl. J. Med., November 14, 2002; 347(20): 1615 - 1617. [Full Text] [PDF]

				D. L. Bhatt, E. J. Topol, I. Kushner, and A. Sehgal The Arterial Inflammation Hypothesis Arch Intern Med, October 28, 2002; 162(19): 2249 - 2251. [Full Text] [PDF]