The conundrum of C-reactive protein as a risk marker for cardiovascular risk assessment: Insight from EPIC-Norfolk and JUPITER

摘要

The challenge presented by the need to identify individuals with moderate cardiovascular risk who go on to undergo a clinical event remains a topic of intense debate. Subjects in this group present a SCORE of 1-5% at 10 years, and are typified by middle-aged men and women, an ever-expanding group as demographic patterns change worldwide. It is therefore of considerable relevance that criteria for risk assessment in this group in the recent Joint ESC/EAS Guideline recommendations for management of dyslipidaemia not only feature a lower target for LDL-cholesterol (LDL-C; 115 mg/dL), but also emphasize the critical need for estimation of the total cardiovascular risk profile. Such an approach to risk evaluation in primary prevention must now, however, integrate the concept of lifetime risk burden, which has the distinct advantage of integrating cumulative risk exposure as compared with a 'point' estimate at any given moment over a lifetime. A further dimension of risk assessment to enhance predictive power in this group concerns the potential use of circulating biomarkers of inflammation, either alone or in a multimarker panel. Use of high-sensitivity C-reactive protein, which, amongst other biomarkers, is associated with cardiovascular risk, has been prominent in such analyses. In this issue of the journal, and in continuity with their recent publications, Sondermeijer and colleagues have focused on the evaluation of both cardiovascular risk and the risk of future coronary heart disease (CHD) events in subjects at moderate risk in the large UK-based EPIC-Norfolk prospective population study, and included high-sensitivity C-reactive protein as a biomarker of systemic inflammation.