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New evidences for C-reactive protein (CRP) deposits in the arterial intima as a cardiovascular risk factor.

Montecucco F, Mach F - Clin Interv Aging (2008)

Bottom Line: The recent demonstration of CRP production not only by the liver, but also within atherosclerotic plaques by activated vascular cells, also suggests a possible dual role, as both a systemic and tissue agent.Although more studies are needed, some therapeutic approaches to reduce CRP levels have been performed with encouraging results.The measure of serum CRP might be useful only for patients who are considered at intermediate risk.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Foundation for Medical Research, University Hospital, Geneva, Switzerland.

ABSTRACT
Inflammatory processes are orchestrated by several soluble molecules, which interact with cell populations involved. Cytokines, chemokines, acute-phase reactants, and hormones are crucial in the evolution of several inflammatory disorders, such as atherosclerosis. Several evidences suggest that C-reactive protein (CRP) started to be considered as a cardiovascular risk factor, since CRP directly induces atheroslerosis development. The recent demonstration of CRP production not only by the liver, but also within atherosclerotic plaques by activated vascular cells, also suggests a possible dual role, as both a systemic and tissue agent. Although more studies are needed, some therapeutic approaches to reduce CRP levels have been performed with encouraging results. However, given the strong limitations represented by its low specificity and still accordingly with the American Heart Association, there is no need for high sensitivity CRP screening of the entire adult population as a public-health measure. The measure of serum CRP might be useful only for patients who are considered at intermediate risk.

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Related in: MedlinePlus

Role of C-reactive protein (CRP) in atherosclerotic processes. CRP is a cardiovascular risk factor with a possible dual pro-atherosclerotic activity as both an endocrine or paracrine molecule. Localization of CRP within unstable or ruptured plaques suggests a possible crucial role during acute atherosclerotic events.
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fig1: Role of C-reactive protein (CRP) in atherosclerotic processes. CRP is a cardiovascular risk factor with a possible dual pro-atherosclerotic activity as both an endocrine or paracrine molecule. Localization of CRP within unstable or ruptured plaques suggests a possible crucial role during acute atherosclerotic events.

Mentions: The present review shows recent experimental evidences to support CRP as a potential cardiovascular risk factor with direct activities in cardiovascular disease. Circulating levels of CRP and vascular CRP (localized within atherosclerotic plaques) could play a dual role as an endocrine and a paracrine agent. The properties of CRP localized in arterial intima could also suggest an interesting hypothesis to clarify how in several studies CRP serum levels were not related to the cardiovascular risk. It is possible that CRP deposition within atherosclerotic plaque, rather than serum CRP levels can be involved in atherosclerotic processes (Figure 1). Although the last guidelines on cardiovascular diseases by the European Society of Cardiology do not support CRP as a marker of cardiovascular risk (Nissen and Wolski 2007; Rydén et al 2007; Mancia et al 2007), the American Heart Association (AHA/CDC) suggests that the measurement of CRP dosage might be useful only when physicians are undecided about indications of treatment for patients who are considered at intermediate cardiovascular risk. In this case, hs-CRP test might tip the scale to help a physician on their decision to introduce more intensive treatment (Ridker et al 2007). Since for cardiovascular risk stratification the determination of CRP levels between 1 and 10 mg/L is needed (Pearson et al 2003), the indicated test is hs-CRP measurement, which measures values under 10 mg/L (Libby and Ridker 2004). The AHA also suggests that there is no need for hs-CRP screening of the entire adult population as a public-health measure, mainly because we do not have enough evidence that treatment strategies based on hs-CRP levels improve survival or reduce cardiovascular complications. To clarify this finding, further prospective studied are needed (Tchernof et al 2002). Therefore, although the AHA experts identified a subgroup of patients who may benefit from hs-CRP testing, at present, for most patients the emphasis must remain on detection, treatment and control of the major cardiovascular risk factors indicated by The Framingham Study, with the inclusion of obesity.


New evidences for C-reactive protein (CRP) deposits in the arterial intima as a cardiovascular risk factor.

Montecucco F, Mach F - Clin Interv Aging (2008)

Role of C-reactive protein (CRP) in atherosclerotic processes. CRP is a cardiovascular risk factor with a possible dual pro-atherosclerotic activity as both an endocrine or paracrine molecule. Localization of CRP within unstable or ruptured plaques suggests a possible crucial role during acute atherosclerotic events.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2546477&req=5

fig1: Role of C-reactive protein (CRP) in atherosclerotic processes. CRP is a cardiovascular risk factor with a possible dual pro-atherosclerotic activity as both an endocrine or paracrine molecule. Localization of CRP within unstable or ruptured plaques suggests a possible crucial role during acute atherosclerotic events.
Mentions: The present review shows recent experimental evidences to support CRP as a potential cardiovascular risk factor with direct activities in cardiovascular disease. Circulating levels of CRP and vascular CRP (localized within atherosclerotic plaques) could play a dual role as an endocrine and a paracrine agent. The properties of CRP localized in arterial intima could also suggest an interesting hypothesis to clarify how in several studies CRP serum levels were not related to the cardiovascular risk. It is possible that CRP deposition within atherosclerotic plaque, rather than serum CRP levels can be involved in atherosclerotic processes (Figure 1). Although the last guidelines on cardiovascular diseases by the European Society of Cardiology do not support CRP as a marker of cardiovascular risk (Nissen and Wolski 2007; Rydén et al 2007; Mancia et al 2007), the American Heart Association (AHA/CDC) suggests that the measurement of CRP dosage might be useful only when physicians are undecided about indications of treatment for patients who are considered at intermediate cardiovascular risk. In this case, hs-CRP test might tip the scale to help a physician on their decision to introduce more intensive treatment (Ridker et al 2007). Since for cardiovascular risk stratification the determination of CRP levels between 1 and 10 mg/L is needed (Pearson et al 2003), the indicated test is hs-CRP measurement, which measures values under 10 mg/L (Libby and Ridker 2004). The AHA also suggests that there is no need for hs-CRP screening of the entire adult population as a public-health measure, mainly because we do not have enough evidence that treatment strategies based on hs-CRP levels improve survival or reduce cardiovascular complications. To clarify this finding, further prospective studied are needed (Tchernof et al 2002). Therefore, although the AHA experts identified a subgroup of patients who may benefit from hs-CRP testing, at present, for most patients the emphasis must remain on detection, treatment and control of the major cardiovascular risk factors indicated by The Framingham Study, with the inclusion of obesity.

Bottom Line: The recent demonstration of CRP production not only by the liver, but also within atherosclerotic plaques by activated vascular cells, also suggests a possible dual role, as both a systemic and tissue agent.Although more studies are needed, some therapeutic approaches to reduce CRP levels have been performed with encouraging results.The measure of serum CRP might be useful only for patients who are considered at intermediate risk.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Foundation for Medical Research, University Hospital, Geneva, Switzerland.

ABSTRACT
Inflammatory processes are orchestrated by several soluble molecules, which interact with cell populations involved. Cytokines, chemokines, acute-phase reactants, and hormones are crucial in the evolution of several inflammatory disorders, such as atherosclerosis. Several evidences suggest that C-reactive protein (CRP) started to be considered as a cardiovascular risk factor, since CRP directly induces atheroslerosis development. The recent demonstration of CRP production not only by the liver, but also within atherosclerotic plaques by activated vascular cells, also suggests a possible dual role, as both a systemic and tissue agent. Although more studies are needed, some therapeutic approaches to reduce CRP levels have been performed with encouraging results. However, given the strong limitations represented by its low specificity and still accordingly with the American Heart Association, there is no need for high sensitivity CRP screening of the entire adult population as a public-health measure. The measure of serum CRP might be useful only for patients who are considered at intermediate risk.

Show MeSH
Related in: MedlinePlus