CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease

Abstract

Abstract-There is great interest in moving beyond established risk factors to consider markers of inflammation for the prediction of initial cardiovascular disease events. Inflammatory markers such as leukocyte count, serum amyloid A, C-reactive protein, and vascular outcomes in individuals free of cardiovascular disease at baseline are the key markers that have been investigated in the population setting. A meta-analysis of 11 prospective studies in asymptomatic individuals compared people in the bottom third of the C-reactive protein distribution with those in the top tertile. The authors reported an odds ratio of 2.0 (95% CI 1.6 to 2.5) for coronary heart disease among people in the top tertile. These results are among the strongest assembled thus far to recommend incorporating newer biomarkers into coronary heart disease risk estimation algorithms. A variety of issues should be considered and conditions satisfied before vascular disease risk factors are adopted into regular use. The type of vascular event and the follow-up interval are important features because results for short-, intermediate-, and long-term intervals may yield different results. The factors under consideration should have been standardized, and characteristics such as the variability of the measurements, correlations with established factors, evidence from observational studies and clinical trials, type of effect (linear, nonlinear, dichotomous), improvement in overall prediction (discrimination), generalization of results (calibration), and cost can affect the utility. Each of these issues needs to be considered and the effects on relative, absolute, and population-attributable risks described. In particular, we need to (1) develop sound strategies for implementing new testing and (2) demonstrate the benefit of testing by using the current foundation of prior probabilities developed from already-published risk factor assessments based on large population studies. Key Words: AHA Scientific Statements Ⅲ inflammation Ⅲ cardiovascular diseases Ⅲ homocysteine Ⅲ C-reactive protein V ascular disease is caused by many factors acting in concert. Several processes foster an atherosclerotic milieu within the coronary arteries, and clinical events are associated with temporary or permanent occlusions of these vessels. 1 Research generally has demonstrated that lipids and blood pressure are critical ingredients that promote the long-term development of atherosclerosis, that cigarette smoking acts more as a precipitating factor, and that diabetes mellitus effects include several pathophysiological mechanisms. Each of these factors is used to estimate coronary heart disease (CHD) risk, but inflammatory and hematologic markers currently are not included in the roster of factors that are used to predict vascular disease risk in the population setting. We have a smaller body of data about the risks of vascular disease related to many of the newer inflammatory factors that predict vascular disease risk, but we do have information on several markers, includ...

Von Willebrand factor predicts major bleeding and mortality during oral anticoagulant treatment

“…In addition, hsCRP has been considered to be a sensitive marker of inflammation and to be associated with cardiovascular events, [20] irrespective of a relation with VWF levels [21]. In the present study, adjustment for hsCRP did not affect the association between VWF and bleeding complications or mortality, indicating that inflammation alone cannot explain our findings.…”

Systemic Immune Mediators and Lifestyle Changes in the Prevention of Type 2 Diabetes

“…First, we found that in the group with little changes in lifestyle (control group), elevated levels of CRP were associated with increased type 2 diabetes incidence. Elevated CRP is by far the best characterized immunological risk factor for incident type 2 diabetes because international standards for the assessment of CRP levels exist (26,27) and because this association could be confirmed in a range of independent studies (9 -12,14,15). Previous studies have shown that elevated CRP levels indicate increased risk of type 2 diabetes in population-based cohorts (8 -10).…”

Reduced Kidney Function Is Associated With Cardiometabolic Risk Factors, Prevalent and Predicted Risk of Cardiovascular Disease in Chinese Adults: Results From the REACTION Study

“…Activation of the RAS, which may partly depend on the adaptation to loss of renal mass that results in changes in renal hemodynamics, frequently occurs in CKD. Furthermore, inflammatory markers, such as leukocyte count, serum amyloid A, C‐reactive protein, fibrinogen, interleukin‐6, tumor necrosis factor‐α, D‐dimer, and the adhesion molecule, E‐selection, are often elevated, and these factors may alter the progression of atherosclerosis through their contribution to the production of reactive oxygen species 31, 32…”