Inflammatory biomarkers are robust predictors—not necessarily of plaque burden—but of the propensity of a plaque to rupture, according to Dr. Verma. Traditionally, risk factors such as cholesterol and diabetes have been used to predict the risk of vascular disease. However, as illustrated in the study by Khot et al., more than 60% of patients suffering from coronary heart disease are seemingly healthy men and women having one or none of these risk factors. Consequently, there is a need for better risk stratification using clinical tools that are reliable and easy to use. Inflammation contributes to all stages of atherosclerosis. Dr. Verma describes the cellular processes affected by inflammation, leading to plaque formation and rupture.

Among the known markers of cardiovascular risk there are different types, related to imaging, immunology, lipids, serum glycoproteins, coagulation, adhesion molecules, genetics, inflammation and proliferation. A number of studies have validated high-sensitivity C-reactive protein (hs)CRP, a marker of inflammation, as a prognostic indicator for cardiovascular disease, and there is in vitro and in vivo data to suggest that CRP promotes atherosclerotic processes. Whether CRP is actually a causal agent is still to be conclusively determined. Dr. Verma describes challenges in the experimentation to ascertain this point, and the relationship of CRP levels to visceral obesity.

In addition to hsCRP being a prognostic indicator of cardiovascular disease, patients with high hsCRP may derive more benefit from aspirin and other risk reducing interventions such as statins. Dr. Verma discusses the epidemiological and clinical trial data to support these concepts, and gives an illustration of the Reynolds Risk Score which utilizes family history and hsCRP in addition to traditional risk factors.

Copyright ©2009 American Academy of CME and E-MedHosting.com Inc.

After viewing this presentation the participant will be able to:
• Recognize patients at elevated vascular risk as indicated by chronic low-grade systemic inflammation
• Select patients for further risk stratification after using the Framingham Risk Score
• Utilize the Reynolds Risk Score which takes into account family history and hsCRP

Erling Falk, MD, PhD; Prediman K. Shah, MD; Valentin Fuster, MD, PhD Coronary Plaque Disruption. Circulation. 1995;92:657-671.

Umesh N. Khot, MD; Monica B. Khot, MD; Christopher T. Bajzer, MD; Shelly K. Sapp, MS; E. Magnus Ohman, MD; Sorin J. Brener, MD; Stephen G. Ellis, MD; A. Michael Lincoff, MD; Eric J. Topol, MD Prevalence of Conventional Risk Factors in Patients With Coronary Heart Disease. JAMA. 2003;290:898-904.

Christopher K. Glass and Joseph L. Witztum Atherosclerosis: The Road Ahead. Cell 2001;104(4):503-516.

Paul M. Ridker, MD, Mary Cushman, MD, Meir J. Stampfer, MD, Russell P. Tracy, PhD, and Charles H. Hennekens, MD Inflammation, Aspirin, and the Risk of Cardiovascular Disease in Apparently Healthy Men. N Engl J Med. 1997 Apr 3;336(14):973-9.

Paul M. Ridker, MD, Charles H. Hennekens, MD, Julie E. Buring, ScD, and Nader Rifai, PhD C-Reactive Protein and Other Markers of Inflammation in the Prediction of Cardiovascular Disease in Women. N Engl J Med. 2000 Mar 23;342(12):836-43.

Benjamin M. Scirica, MD, MPH; David A. Morrow, MD, MPH Is C-reactive protein an innocent bystander or proatherogenic culprit? Circulation. 2006;113:2128-2151.

Paul M Ridker, MD, Eleanor Danielson, MIA, Francisco A.H. Fonseca, MD, Jacques Genest, MD, Antonio M. Gotto, Jr., MD, John J.P. Kastelein, MD, Wolfgang Koenig, MD, Peter Libby, MD, Alberto J. Lorenzatti, MD, Jean G. MacFadyen, BA, Børge G. Nordestgaard, MD, James Shepherd, MD, James T. Willerson, MD, Robert J. Glynn, ScD, for the JUPITER Study Group Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. N Engl J Med. 2008 Nov 20;359(21):2195-207.

Paul M Ridker, MD, MPH; Julie E. Buring, ScD; Nader Rifai, PhD; Nancy R. Cook, ScD Development and Validation of Improved Algorithms for the Assessment of Global Cardiovascular Risk in Women: The Reynolds Risk Score. JAMA. 2007;297:611-619.