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(Circulation. 2004;109:II-2 – II-10.)
© 2004 American Heart Association, Inc.

Vascular Effects of Statins

Inflammation as a Cardiovascular Risk Factor

James T. Willerson, MD; Paul M. Ridker, MD, MPH

From the University of Texas Health Science Center and Texas Heart Institute at Houston (J.T.W.), University of Texas, Houston Medical School, Houston, Tex; and Harvard Medical School (P.M.R.), Center for Cardiovascular Disease Prevention, Brigham and Women’s Hospital, Boston, Mass.

Correspondence to James T. Willerson, MD, Edward Randall III Professor and President, University of Texas, Houston Health Science Center, Houston, TX 77225. E-mail james.t.willerson{at}uth.tmc.edu

Abstract

Inflammation occurs in the vasculature as a response to injury, lipid peroxidation, and perhaps infection. Various risk factors, including hypertension, diabetes, and smoking, are amplified by the harmful effects of oxidized low-density–lipoprotein cholesterol, initiating a chronic inflammatory reaction, the result of which is a vulnerable plaque, prone to rupture and thrombosis. Epidemiological and clinical studies have shown strong and consistent relationships between markers of inflammation and risk of future cardiovascular events. Inflammation can potentially be detected locally by imaging techniques as well as emerging techniques, such as identification of temperature or pH heterogeneity. It can be detected systemically by measurement of inflammatory markers. Of these, the most reliable and accessible for clinical use is currently high-sensitivity C-reactive protein. A combination of methods may provide the best identification of persons at risk for cardiovascular events who would benefit from treatment. In randomized, controlled trials, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, in the form of statins, have been shown to provide effective therapy for lowering CRP, in conjunction with their lipid-lowering effects. Although the magnitude of risk reduction associated with statin use appears to be largest for those with the highest serum levels of CRP, whether CRP reduction per se lowers cardiovascular risk is unknown.

Key Words: inflammation • C-reactive protein • local detection • systemic detection

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