Association of C-reactive protein and serum amyloid A with recurrent coronary events in stable patients after healing of acute myocardial infarction

Pathologic studies have demonstrated the presence of inflammation at various stages of atherosclerosis implying an important role for inflammatory processes in coronary disease.(1) Macrophage and lymphocyte infiltrates have been detected across the spectrum of atherosclerotic lesions from the precursor fatty streak found in children to the complex plaque obtained at autopsy from victims of fatal myocardial infarction. Inflammation is also implicated as a major determinant of plaque vulnerability, and several inflammatory processes are thought to contribute to plaque rupture.(2) Accordingly, recent studies have focused on the measurement of inflammatory markers including high sensitivity C-reactive protein (CRP) and serum amyloid A (SAA) as predictors of subsequent cardiac events.(3,4) The prognostic value of CRP has been tested in a variety of clinical settings. In healthy subjects, elevated levels of CRP are independent markers for subsequent cardiovascular events in some but not all(5) reported studies. In patients with symptomatic coronary artery disease but without evidence of myocardial necrosis, elevated CRP has been shown to be associated with increased cardiovascular risk in patients with stable and unstable angina pectoris.(3) In addition, CRP has been reported to have prognostic value in acute coronary syndromes.(5,6) We evaluated the association of CRP and SAA levels with recurrent coronary events in a large prospective study of stable postinfarction patients.(7)