Predicting risk and treatment benefit in atherosclerosis: the role of C-reactive protein

Inflammatory mechanisms play a prominent role in mediating all stages of atherosclerosis, and measurement of inflammatory biomarkers provides a method for detecting individuals at future vascular risk. Evidence from observational studies indicates that the hepatic acute-phase reactant, C-reactive protein (CRP), is the strongest predictor of future myocardial infarction and stroke. The addition of CRP to standard lipid screening may improve global risk prediction among those with high as well as low cholesterol. Statins have been shown to have beneficial effects on plaque inflammation, stability and CRP levels, in addition to their lipid-lowering effects. Data from two large statin trials suggest that testing for CRP may identify many individuals without hyperlipidaemia who are at high risk for future cardiovascular events and who may benefit from statin therapy. If confirmed in ongoing large-scale prospective trials, screening for inflammation using CRP as a biomarker could prove an important adjunctive method for identifying individuals at increased risk who would benefit most from targeted preventive interventions.