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C-reactive Protein — a Prognostic Marker of Inflammation in Atherothrombosis

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Inflammatory and Infectious Basis of Atherosclerosis

Part of the book series: Progress in Inflammation Research ((PIR))

Abstract

Though significant advancements continue in the management of unstable ischemic heart disease, preventive interventions with a similar magnitude of benefit have the potential to reduce the number of cardiovascular deaths each year by more than 100,000 in the United States alone [1]. Epidemiological data have established important risk factors for atherosclerotic vascular disease, including advanced age, tobacco use, obesity, diabetes, hypertension and dyslipidemia. However, up to one third of first coronary events occur among individuals without these traditional risk factors [2]. Thus, efforts to identify additional indicators of cardiovascular prognosis that add to the predictive information from traditional risk factors, and that might aid in targeting therapy are central to improving the preventive strategies.

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References

  1. Manson JE, Ridker PM, Gaziano JM, Hennekens CH (1997)Primary prevention of myocardial infarction.Oxford University Press, New York

    Google Scholar 

  2. Ridker PM, Haughie P (1998) Prospective studies of C-reactive protein as a risk factor for cardiovascular disease.J Investig Med46: 391–395

    PubMed  CAS  Google Scholar 

  3. Ridker P (1997) Fibrinolytic and inflammatory markers for arterial occlusion: the evolv-ing epidemiology of thrombosis and hemostasis.Thromb Haemost78: 53–59

    PubMed  CAS  Google Scholar 

  4. Ross R (1999) Atherosclerosis — An inflammatory disease.N Engl J Med340: 115–126

    Article  PubMed  CAS  Google Scholar 

  5. Morrow DA, Ridker PM (1999) Inflammation in cardiovascular disease. In: E Topol (ed):Textbook of cardiovascular medicine updates.Lippincott Williams & Wilkins, Cedar Knolls, 1–12

    Google Scholar 

  6. Biasucci LM, Vitelli A, Liuzzo G, Altamura S, Caligiuri G, Monaco C, Rebuzzi AG,Ciliberto G, Maseri A (1996) Elevated levels of interleukin-6 in unstable angina.Circulation94: 874–877

    Article  PubMed  CAS  Google Scholar 

  7. Harris TB, Ferrucci L, Tracy RP, Corti MC, Wacholder S, Ettinger WH Jr, Heimovitz H, Cohen HJ, Wallace R (1999) Associations of elevated interleukin-6 and C-reactive protein levels with mortality in the elderly.Am J Med106: 506–512

    Article  PubMed  CAS  Google Scholar 

  8. Ikonomidis I, Andreotti F, Economou E, Stefanadis C, Toutouzas P, Nihoyannopoulos P (1999) Increased proinflammatory cytokines in patients with chronic stable angina and their reduction by aspirin.Circulation100: 793–798

    Article  PubMed  CAS  Google Scholar 

  9. Hwang SJ, Ballantyne CM, Sharrett AR, Smith LC, Davis CE, Gotto AM Jr, Boerwinkle E (1997) Circulating adhesion molecules VCAM-1, ICAM-1, and E-selectin in carotid atherosclerosis and incident coronary heart disease cases: the Atherosclerosis Risk In Communities (AMC) study.Circulation96: 4219–4225

    Article  PubMed  CAS  Google Scholar 

  10. Ridker PM, Hennekens CH, Roitman-Johnson B, Stampfer MJ, Allen J (1998) Plasma concentration of soluble intercellular adhesion molecule 1 and risk of future myocardial infarction in apparently healthy men.Lancet351: 88–92

    Article  PubMed  CAS  Google Scholar 

  11. Aukrust P, Mu F, Ueland T, Berget T, Aaser E, Brunsvig A, Solum NO, Forfang K, Froland SS, Gullestad L (1999) Enhanced levels of soluble and membrane-bound CD40 ligand in patients with unstable angina. Possible reflection of T lymphocyte and platelet involvement in the pathogenesis of acute coronary syndromes.Circulation100: 614–620

    Article  PubMed  CAS  Google Scholar 

  12. Kai H, Ikeda H, Yasukawa H, Kai M, Seki Y, Kuwahara F, Ueno T, Sugi K, Imaizumi T (1998) Peripheral blood levels of matrix metalloproteases-2 and -9 are elevated in patients with acute coronary syndromes.J Am Coll Cardiol32: 368–372

    Article  PubMed  CAS  Google Scholar 

  13. Pepys MB, Baltz ML (1983) Acute phase proteins with special reference to C-reactive protein and related proteins (pentaxins) and serum amyloid A protein.Adv Immunol34: 141–212

    Article  PubMed  CAS  Google Scholar 

  14. Macy E, Hayes T, Tracy R (1997) Variability in the measurement of C-reactive protein in healthy subjects: implications for reference interval and epidemiologic applications.Clin Chem43: 52–58

    PubMed  CAS  Google Scholar 

  15. Ledue TB, Weiner DL, Sipe JD, Poulin SE, Collins MF, Rifai N (1998) Analytical evaluation of particle-enhanced immunonephelometric assays for C-reactive protein, serum amyloid A and mannose-binding protein in human serum.Ann Clin Biochem35: 745–753

    PubMed  CAS  Google Scholar 

  16. Wilkins J, Gallimore R, Moore E, Pepys M (1998) Rapid automated high sensitivity enzyme immunoassay of C-reactive protein.Clin Chem44: 1358–1361

    PubMed  CAS  Google Scholar 

  17. Rifai N, Tracy RP, Ridker PM (1999) Clinical efficacy of an automated high-sensitivity C-reactive protein assay.Clin Chem45: 2136–2141

    PubMed  CAS  Google Scholar 

  18. Mendall MA, Patel P, Ballam L, Strachan D, Northfield TC (1996) C reactive protein and its relation to cardiovascular risk factors: a population based cross sectional study.BMJ312: 1061–1065

    Article  PubMed  CAS  Google Scholar 

  19. Berk BC, Weintraub WS, Alexander RW (1990) Elevation of C-reactive protein in “active” coronary artery disease.Am J Cardiol65: 168–172

    Article  PubMed  CAS  Google Scholar 

  20. Pietila K, Harmoinen A, Poyhonen L, Ruosteenoja R (1986) C-reactive protein in subendocardial and transmural myocardial infarcts.Clin Chem32: 1596–1597

    PubMed  CAS  Google Scholar 

  21. Tracy RP, Psaty BM, Macy E, Bovill EG, Cushman M, Cornell ES, Kuller LH (1997) Lifetime smoking exposure affects the association of C-reactive protein with cardiovascular disease risk factors and subclinical disease in healthy elderly subjects.Arterioscler Thromb Vasc Biol17: 2167–2176

    Article  PubMed  CAS  Google Scholar 

  22. Ridker PM (1999) Evaluating novel cardiovascular risk factors: can we better predict heart attacks?Ann Intern Med130: 933–937

    PubMed  CAS  Google Scholar 

  23. Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH (1997) Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men.N Engl J Med336: 973–979

    Article  PubMed  CAS  Google Scholar 

  24. Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH (1998) Prospective study of C-reactive protien and the risk of future cardiovascular events among apparently healthy women.Circulation98: 731–733

    Article  PubMed  CAS  Google Scholar 

  25. Koenig W, Sund M, Froehlich M, Fischer H, Lowel H, Doering A, Hutchinson W, Pepys M (1999) C-reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: Results from the MONICA (Monitoring trends and determinants in cardiovascular disease) Augsberg Cohort Study, 1984 to 1992.Circulation99: 237–242

    Article  PubMed  CAS  Google Scholar 

  26. Tracy RP, Lemaitre RN, Psaty BM, Ives DG, Evans RW, Cushman M, Meilahn EN, Kuller LH (1997) Relationship of C-reactive protein to risk of cardiovascular disease in the elderly. Results from the Cardiovascular Health Study and the Rural Health Promotion Project.Arterioscler Thromb Vasc Biol17: 1121–1127

    Article  PubMed  CAS  Google Scholar 

  27. Kuller LH, Tracy RP, Shaten J, Meilahn EN (1996) Relation of C-reactive protein and coronary heart disease in the MRFIT nested case-control study. Multiple Risk Factor Intervention Trial.Am J Epidemiol144: 537–547

    Article  PubMed  CAS  Google Scholar 

  28. Haverkate F, Thompson SG, Pyke SD, Gallimore JR, Pepys MB (1997) Production of C-reactive protein and risk of coronary events in stable and unstable angina. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group.Lancet349: 462–466

    Article  PubMed  CAS  Google Scholar 

  29. Liuzzo G, Biasucci LM, Gallimore JR, Grillo RL, Rebuzzi AG, Pepys MB, Maseri A (1994) The prognostic value of C-reactive protein and serum amyloid a protein in severe unstable angina.N Engl J Med331: 417–424

    Article  PubMed  CAS  Google Scholar 

  30. Morrow DA, Rifai N, Antman EM, Weiner D, McCabe CM, Cannon CP, Braunwald E (1998) C-Reactive protein is a potent predictor of mortality independently and in combination with troponin T in acute coronary syndromes.J Am Coll Cardiol31: 1460–1465

    Article  PubMed  CAS  Google Scholar 

  31. Ridker PM, Rifai N, Pfeffer MA, Sacks FM, Moye LA, Goldman S, Fiaker GC, Braunwald E (1998) Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events (CARE) Investigators.Circulation98: 839–844

    Article  PubMed  CAS  Google Scholar 

  32. Steering Committee of the Physicians’ Health Study Research G (1989) Final report on the aspirin component of the ongoing Physicians’ Health Study.N Engl J Med321: 129–135

    Article  Google Scholar 

  33. Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH (1998) Plasma concentration of C-reactive prtoein and risk of developing peripheral vascular disease.Circulation97: 425–428

    Article  PubMed  CAS  Google Scholar 

  34. Ridker PM, Hennekens CH, Rifai N, Buring JE, Manson JE (1999) Hormone replacement therapy and increased plasma concentration of C-reactive protein.Circulation100: 713–716

    Article  PubMed  CAS  Google Scholar 

  35. Cushman M, Legault C, Barrett-Connor E, Stefanick ML, Kessler C, Judd HL, Sakkinen PA, Tracy RP (1999) Effect of postmenopausal hormones on inflammation-sensitive proteins: the Postmenopausal Estrogen/Progestin Interventions (PEPI) Study.Circulation100: 717–722

    Article  PubMed  CAS  Google Scholar 

  36. Cushman M, Meilahn EN, Psaty BM, Kuller LH, Dobs AS, Tracy RP (1999) Hormone replacement therapy, inflammation, and hemostasis in elderly women.Arterioscler Thromb Vasc Biol19: 893–899

    Article  PubMed  CAS  Google Scholar 

  37. Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, Vittinghoff E (1998) Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group.JAMA280: 605–613

    Article  PubMed  CAS  Google Scholar 

  38. Ridker PM, Glynn RJ, Hennekens CH (1998) C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction.Circulation97: 2007–2011

    Article  PubMed  CAS  Google Scholar 

  39. Cermak J, Key NS, Bach RR, Balla J, Jacob HS, Vercellotti GM (1993) C-reactive protein induces human peripheral blood monocytes to synthesize tissue factor.Blood82: 513–520

    PubMed  CAS  Google Scholar 

  40. Wolbink GJ, Brouwer MC, Buysmann S, ten Berge IJ, Hack CE (1996) CRP-mediated activation of complementin vivo:assessment by measuring circulating complement-Creactive protein complexes.J Immunol157: 473–479

    PubMed  CAS  Google Scholar 

  41. Zouki C, Beauchamp M, Baron C, Filep J (1997) Prevention ofin vitroneutrophil adhesion to endothelial cells through shedding of L-selectin by C-reactive protein and peptides derived from C-reactive protein.J Clin Invest 100:522–529

    Article  PubMed  CAS  Google Scholar 

  42. Bataille R, Klein B (1992) C-reactive protein levels as a direct indicator of interleukin-6 levels in humans in vivo.Arthritis & Rheumatism35: 982–984

    Article  CAS  Google Scholar 

  43. Van Snick J (1990) Interleukin-6: an overview.Ann Rev Immunol8: 253–278

    Article  Google Scholar 

  44. Mestries JC, Kruithof EK, Gascon MP, Herodin F, Agay D, Ythier A (1994) In vivo modulation of coagulation and fibrinolysis by recombinant glycosylated human interleukin6 in baboons.European Cytokine Network5: 275–281

    PubMed  CAS  Google Scholar 

  45. Stouthard JM, Levi M, Hack CE, Veenhof CH, Romijn HA, Sauerwein HP, van der Poll T (1996) Interleukin-6 stimulates coagulation, not fibrinolysis, in humans.Thromb Haemost76: 738–742

    PubMed  CAS  Google Scholar 

  46. Biasucci LM, Liuzzo G, Fantuzzi G, Caligiuri G, Rebuzzi AG, Ginnetti F, Dinarello CA, Maseri A (1999) Increasing levels of interleukin (IL)-1Ra and IL-6 during the first 2 days of hospitalization in unstable angina are associated with increased risk of in-hospital coronary events.Circulation99: 2079–2084

    Article  PubMed  CAS  Google Scholar 

  47. Ridker PM, Rifai N, Stampfer MJ, Hennekens CH (2000) Plasma concentration of interleukin-6 and the risk of future myocardial infarction among apparently healthy men.Circulation 101:1767–1772

    Article  PubMed  CAS  Google Scholar 

  48. Danesh J, Collins R, Appleby P, Peto R (1998) Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA 279: 1477–1482

    Article  PubMed  CAS  Google Scholar 

  49. Ridker PM, Rifai N, Pfeffer M, Sacks F, Lepage S, Braunwald E (2000) Elevation of tumor necrosis factor-alpha and increased risk of recurrent coronary events following myocardial infarction.Circulation 101:2149–2153

    Article  PubMed  CAS  Google Scholar 

  50. Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JD, Cole TG, Brown L, Warnica JW, Arnold JM, Wun CC et al (1996) The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators.N Engl J Med335: 1001–1009

    Article  PubMed  CAS  Google Scholar 

  51. Vaughan CJ, Murphy MB, Buckley BM (1996) Statins do more than just lower cholesterol.Lancet348: 1079–1082

    Article  PubMed  CAS  Google Scholar 

  52. Corsini A, Bernini F, Quarato P, Donetti E, Bellosta S, Fumagalli R, Paoletti R, Soma VM (1996) Non-lipid-related effects of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors.Cardiology87: 458–468

    Article  PubMed  CAS  Google Scholar 

  53. Kurakata S, Kada M, Shimada Y, Komai T, Nomoto K (1996) Effects of different inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, pravastatin sodium and simvastatin, on sterol synthesis and immunological functions in human lymphocytes in vitro.Immunopharmacology34: 51–61

    Article  PubMed  CAS  Google Scholar 

  54. Munro E, Patel M, Chan P, Betteridge L, Clunn G, Gallagher K, Hughes A, Schachter M, Wolfe J, Sever P (1994) Inhibition of human vascular smooth muscle cell proliferation by lovastatin: the role of isoprenoid intermediates of cholesterol synthesis.Eur J Clin Invest24: 766–772

    Article  PubMed  CAS  Google Scholar 

  55. Rogler G, Lackner KJ, Schmitz G (1995) Effects of fluvastatin on growth of porcine and human vascular smooth muscle cellsin vitro. Am J Cardiol76: 114A–116A

    Article  PubMed  CAS  Google Scholar 

  56. Rosenson RS, Tangney CC (1998) Antiatherothrombotic properties of statins: implications for cardiovascular event reduction.JAMA279: 1643–1650

    Article  PubMed  CAS  Google Scholar 

  57. Shiomi M, Ito T, Tsukada T, Yata T, Watanabe Y, Tsujita Y, Fukami M, Fukushige J, Hosokawa T, Tamura A (1995) Reduction of serum cholesterol levels alters lesional composition of atherosclerotic plaques. Effect of pravastatin sodium on atherosclerosis in mature WHHL rabbits.Arterioscler Thromb Vasc Biol15: 1938–1944

    Article  PubMed  CAS  Google Scholar 

  58. Williams JK, Sukhova GK, Herrington DM, Libby P (1998) Pravastatin has cholesterol-lowering independent effects on the artery wall of atherosclerotic monkeys.J Am Coll Cardiol31: 684–691

    Article  PubMed  CAS  Google Scholar 

  59. Ridker PM, Rifai N, Pfeffer MA, Sacks FM, Braunwald E (1999) Long-term effects of pravastatin on plasma concentration of C-reactive protein.Circulation 100:230–235

    Article  PubMed  CAS  Google Scholar 

  60. Aikawa M, Rabkin E, Okada Y, Voglic SJ, Clinton SK, Brinckerhoff CE, Sukhova GK, Libby P (1998) Lipid lowering by diet reduces matrix metalloproteinase activity and increases collagen content of rabbit atheroma: a potential mechanism of lesion stabilization.Circulation97: 2433–2444

    Article  PubMed  CAS  Google Scholar 

  61. Aikawa M, Voglic S, Rabkin E, Shiomi M, Libby P (1998) An HMG-CoA reductase inhibitor (cervistatin) supresses accumulation of macrophages expressing matrix metalloproteinases and tissue factor in atheroma of WHHL rabbits.Circulation98: I-47

    Google Scholar 

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Morrow, D.A., Ridker, P.M. (2001). C-reactive Protein — a Prognostic Marker of Inflammation in Atherothrombosis. In: Mehta, J.L. (eds) Inflammatory and Infectious Basis of Atherosclerosis. Progress in Inflammation Research. Birkhäuser, Basel. https://doi.org/10.1007/978-3-0348-8239-2_13

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  • DOI: https://doi.org/10.1007/978-3-0348-8239-2_13

  • Publisher Name: Birkhäuser, Basel

  • Print ISBN: 978-3-0348-9487-6

  • Online ISBN: 978-3-0348-8239-2

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