C-reactive protein and other inflammatory risk markers in acute coronary syndromes

Abstract

Markers of myocyte necrosis such as cardiac troponin or creatine kinase-myocardial band are invaluable tools for risk stratification among patients presenting with acute coronary syndromes (ACS). Nonetheless, many patients without any evidence of myocyte necrosis may be at high risk for recurrent ischemic events. In consideration of the important role that inflammatory processes play in determining plaque stability, recent work has focused on whether plasma markers of inflammation may help improve risk stratification. Of these markers, C-reactive protein (CRP) has been the most widely studied, and there is now robust evidence that CRP is a strong predictor of cardiovascular risk among apparently healthy individuals, patients undergoing elective revascularization procedures, and patients presenting with ACS. Moreover, even among patients with troponin-negative ACS, elevated levels of CRP are predictive of future risk. Other, more upstream markers of the inflammatory cascade, such as interleukin (IL)-6, have also been found to be predictive of recurrent vascular instability. A recent report from the second FRagmin during InStability in Coronary artery disease trial investigators suggests that elevated levels of an inflammatory marker such as IL-6 may indicate which patients may benefit most from an early invasive strategy. Other inflammatory markers currently under investigation include lipoprotein-associated phospholipase A(2), myeloperoxidase, and pregnancy-associated plasma protein A. Of all these novel markers, CRP appears to meet most of the criteria required for potential clinical application. Furthermore, the benefits of lifestyle modification and drug therapy with aspirin or statins may be most marked among those with elevated CRP levels.

“Upstream markers” provide for early identification of patients at high risk for myocardial necrosis and adverse outcomes

“…We examined biomarkers that represent distinct phases of the ACS spectrum, such as inflammation, endothelial and myocardial dysfunction. Inflammation is thought to play an important role in the events preceding plaque rupture, with many publications documenting the role of CRP in ACS [26]. However, earlier mediators of inflammation, for example IL-6, not only result in CRP production by the liver [26] but IL-6 concentrations have also been reported to be derived from cardiac sources in ACS patients [6,27].…”

Impact of Supplementing Preoperative Intravenous Omega 3 Fatty Acids in Fish Oil on Immunomodulation in Elderly Patients Undergoing Hip Surgery

“…HS-CRP and IL-6 are markers of systemic inflammation and independent predictors of cardiovascular disease in healthy women. Recent data suggest that HS-CRP plays an active role in atherogenesis [24]. A study by Burns et al [25] has reported non-significant effect of omega-3 fatty acids on HS-CRP levels.…”

Serial Analyses of C‐Reactive Protein and Myeloperoxidase in Acute Coronary Syndrome

“…13,18 Several variables seem to interfere with the results provided from commercially available kits, such as temperature, coating antibody affinity, type of material analyzed, among others. 19 In addition, there are no definitive data establishing the cut point value of MPO from which it is a predictor of cardiovascular risk.…”

“…CRP was a mortality predictor however, not capable of early identification of a high risk subgroup independently of troponin, as suggested in previous studies. 6,11,19 It seems that markers of necrosis are more related to the extension of myocardial damage and early risk, and inflammatory markers probably identify a profile at higher risk of plaque vulnerability and late events.…”