An About-Face for C-Reactive Protein?

[摘要] Human C-reactive protein (CRP)2 is a liver-synthesized blood constituent, the production of which increases rapidly and robustly in parallel with tissue damage, infection, and trauma (1). Owing to this predictable behavior, increases in the blood concentration of CRP have long been used as a clinical gauge of inflammation (2). More recently, with the introduction of higher-sensitivity laboratory assays, it has become apparent that even a modestly increased baseline CRP concentration in healthy individuals correlates tightly with their increased future risk of cardiovascular disease (3, 4). More than 20 prospective epidemiologic studies carried out in populations of individuals with no prior history of cardiovascular disease have demonstrated that a single CRP measurement at baseline is a strong predictor of future cardiovascular events (4). The relationship between an increased baseline CRP concentration and vascular risk is apparent for both men and women and remains consistent in studies from around the world. In most cases, this relationship is independent of traditional risk factors, including age, smoking, high blood pressure, and high cholesterol concentrations (4). A high preprocedural baseline CRP value is also associated with an increased occurrence of fatal and nonfatal myocardial infarction after percutaneous coronary interventions (4, 5). Notably, the reduction in blood CRP that accompanies statin therapy improves clinical outcomes and decreases the progression of atherosclerotic coronary disease independent of cholesterol lowering, a finding that highlights the possibility of using CRP as a therapeutic target (6–8). Despite indisputable evidence that CRP is associated with inflammation and the risk of cardiovascular disease, the question of whether CRP contributes to either process remains enigmatic. If CRP does participate in the cardiovascular disease process, how does it do so? The report by Fujita et al. in this issue of Clinical Chemistry (9) provides a new clue to help answer …

[学科分类] 过敏症与临床免疫学