Clinical use of high sensitivity C-reactive protein for the prediction of adverse cardiovascular events

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Abstract
Inflammation plays a central role in the initiation, progression, and destabilization of vascular atheroma. In an attempt to improve global cardiovascular risk assessment, considerable research has focused on markers of inflammation; in particular, high-sensitivity C-reactive protein, a pentraxin innate immune recognition molecule and classic acute-phase reactant. Multiple prospective studies now demonstrate that high-sensitivity C-reactive protein is a potent predictor of future cardiovascular events at all levels of low-density lipoprotein cholesterol, all levels of the Framingham Risk Score, and all levels of severity of the metabolic syndrome. Moreover, high-sensitivity C-reactive protein appears to be implicated in acute coronary syndromes and provides prognostic information on vascular risk among patients with renal dysfunction. In clinical settings, high-sensitivity C-reactive protein levels more than 3 mg/L are associated with the highest vascular risk. High-sensitivity C-reactive protein evaluation has recently been endorsed by the Centers for Disease Control and Prevention and by the American Heart Association to be used in conjunction with lipid evaluation as part of global risk prediction. Emerging evidence further suggests that high-sensitivity C-reactive protein can be used to target pharmacologic and lifestyle interventions designed to prevent first as well as recurrent cardiovascular events.