Potent Predictor: Paul M. Ridker on CRP and Cardiovascular Disease

摘要

It took 30 years for researchers to agree that lower serum cholesterol would reduce the risk of heart disease, but they seem to be moving considerably faster when it comes to inflammation. In the past five years, cardiologist Paul M. Ridker and his colleagues at Harvard Medical School's Brigham and Women's Hospital in Boston have managed to amass a compelling amount of data suggesting that a marker for inflammation, known as the C-reactive protein (CRP), is a potent risk factor for cardiovascular disease, and that drugs that reduce CRP levels will reduce heart-disease risk, as well. The extent to which this idea is catching fire with medical researchers is made manifest by Ridker's phenomenal citations. By the summer of 2001, Ridker's articles were perched atop the Science Watch listing of the hottest papers in medicine. "Long-term effects of pravastatin on plasma concentration of C-reactive protein," (PM. Ridker, et al, Circulation, 100 (3):230-5, 20 July 1999) was at #1, followed by "C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women," (P.M. Ridker, et al. New Engl. J. Med., 342(12):836-43, 2000.) at #6. Indeed, in the past decade Ridker has published a dozen papers that have each attracted more than 200 citations, while his seminal work on inflammation and heart disease (PM. Ridker, et al., "Inflammation, aspirin, and the risk of cardiovascular-disease in apparently healthy men," New Engl. J. Med., 336(14): 973-9, 1997) has racked up a remarkable 1,000+ citations in five years (see table on page 4). And that doesn't even include two very recent papers published in the New England Journal of Medicine, one demonstrating how inflammation can be used to target statin therapy (PM. Ridker, et al., New Engl. J. Med., 344(26): 1959-65, 2001), and one demonstrating that inflammation as detected by CRP is a more potent predictor of vascular risk than LDL cholesterol (P.M. Ridker, et al., New Engl. J. Med., in press).