Inflammation in ischaemic heart disease

C Reactive protein concentrations may provide useful information on risk

Recent reports have suggested a link between blood concentrations of C reactive protein and the risk of cardiovascular disease. The ECAT study (European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study) followed 3000 people with chronic stable ischaemic heart disease for three years and found a significant correlation between concentrations of C reactive protein within the normal range and long term cardiovascular risk.1 Raised concentrations have also been shown to be strong prognostic indicators in patients with unstable angina,2 and in this week's BMJ Mendall et al report an association between C reactive protein concentrations and indirect evidence of ischaemic heart disease (p1061).3 What are the pathogenetic implications of this novel marker of acute and chronic manifestations of ischaemic heart disease and its relevance in clinical practice?

Mendall et al studied 303 men aged 50-69 years selected from general practice registers3 and found that the prevalence of indirect evidence of ischaemic heart disease and a history of claudication (together with age, smoking, chronic bronchitis, and most traditional cardiovascular risk factors) increased progressively as blood concentrations of C reactive protein rose. This correlation between C reactive protein and traditional risk factors for ischaemic heart disease may influence prognosis in the long term by favouring the development of atherosclerosis, but the prognostic value of C reactive protein might also result from an increased incidence and worse outcome of …