Inflammation is recognized as playing a major role in atherosclerosis (1), and markers of inflammation have been associated with the risk of future cardiovascular disease.

With regards to the clinical application of inflammatory markers, the American Heart Assocation and the Centers for Disease Control and Prevention have endorsed the optional use of high-sensitivity CRP testing in those at intermediate risk of coronary heart disease over 10 years (2), where the test would add additional information on risk and may influence decisions relating to further evaluation or medical therapy.

Inflammation and thrombosis markers have also been associated with the development of type 2 diabetes. The Insulin Resistance Atherosclerosis Study found that CRP, fibrinogen and PAI-1 predicted the development of type 2 diabetes (3), and in further analyses these biomarkers in prediabetic subjects were found to be associated with insulin resistance and not poor insulin secretion (4).

Much research on markers of inflammation has focused on middle-aged individuals, although a few studies have been done in young (5-7) as well as older (8-10) patients. Dr. Tracy concludes his presentation with a discussion of possible future directions for epidemiological research, for example using assays based on cellular function.

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After viewing this presentation the participant will be able to discuss:

- Inflammatory markers and cardiovascular risk: clinical utility of the hsCRP test
- Inflammation and thrombosis markers in the prediction of diabetes
- Studies on inflammation and thrombosis biomarkers in young and old patients
- Future epidemiological research possibilities using assays based on cellular function

1. Peter Libby, MD Current Concepts of the Pathogenesis of the Acute Coronary Syndromes Circulation. 2001;104:365.

2. Thomas A. Pearson, MD, PhD (Co-Chair); George A. Mensah, MD (Co-Chair); R. Wayne Alexander, MD, PhD; Jeffrey L. Anderson, MD; Richard O. Cannon, III, MD; Michael Criqui, MD; Yazid Y. Fadl, MD; Stephen P. Fortmann, MD; Yuling Hong, MD, PhD; Gary L. Myers, PhD; Nader Rifai, PhD; Sidney C. Smith, Jr, MD; Kathryn Taubert, PhD; Russell P. Tracy, PhD; Frank Vinicor, MD Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: A Statement for Healthcare Professionals From the Centers for Disease Control and Prevention and the American Heart Association Circulation. 2003;107:499.

3. Andreas Festa, Ralph D’Agostino, Jr, Russell P. Tracy, and Steven M. HaffnerElevated Levels of Acute-Phase Proteins and Plasminogen Activator Inhibitor-1 Predict the Development of Type 2 Diabetes - The Insulin Resistance Atherosclerosis StudyDiabetes 51:1131-1137, 2002.


4. Andreas Festa, MD; Anthony J.G. Hanley, PhD; Russell P. Tracy, PhD; Ralph D’Agostino, Jr, PhD; Steven M. Haffner, MD Inflammation in the Prediabetic State Is Related to Increased Insulin Resistance Rather Than Decreased Insulin SecretionCirculation. 2003;108:1822.

5. Earl S. Ford, MD, MPH C-Reactive Protein Concentration and Cardiovascular Disease Risk Factors in Children: Findings From the National Health and Nutrition Examination Survey 1999–2000 Circulation. 2003;108:1053.

6. MA Ferguson, B Gutin, S Owens, M Litaker, RP Tracy and J AllisonFat distribution and hemostatic measures in obese childrenAmerican Journal of Clinical Nutrition. 1998. Vol 67, 1136-1140.

7. Mikko J. Järvisalo; Aimo Harmoinen; Maarit Hakanen; Ulla Paakkunainen; Jorma Viikari; Jaakko Hartiala; Terho Lehtimäki; Olli Simell; Olli T. Raitakari Elevated Serum C-Reactive Protein Levels and Early Arterial Changes in Healthy Children
Arteriosclerosis, Thrombosis, and Vascular Biology. 2002;22:1323.

8. Allen P. Burke, MD; Russell P. Tracy, PhD; Frank Kolodgie, PhD; Gray T. Malcom, PhD; Arthur Zieske, MD; Robert Kutys, MS; Joseph Pestaner, MD; John Smialek, MD; Renu Virmani, MDElevated C-Reactive Protein Values and Atherosclerosis in Sudden Coronary Death: Association With Different Pathologies Circulation. 2002;105:2019.

9. Tamara B. Harris MD, MS, Luigi Ferrucci MD, PhD, Russell P. Tracy PhD, M. Chiara Corti MD, PhD, Sholom Wacholder PhD, Walter H. Ettinger Jr MD, MBA, Harley Heimovitz MS, Harvey J. Cohen MD and Robert Wallace MD, Msc.Associations of elevated Interleukin-6 and C-Reactive protein levels with mortality in the elderlyAm J Med. 1999; 106(5): 506.

10. Mary Cushman; Rozenn N. Lemaitre; Lewis H. Kuller; Bruce M. Psaty; Elizabeth M. Macy; A. Richey Sharrett; Russell P. Tracy Fibrinolytic Activation Markers Predict Myocardial Infarction in the Elderly: The Cardiovascular Health Study ATVB. 1999; 19:493-498.