Inflammatory markers in coronary heart disease

Introduction: Inflammation plays a key role in the development of atherosclerosis and coronary heart disease (CHD). Sources of data: Peer-reviewed studies published in English-language journals were reviewed with a focus on C-reactive protein (CRP) and lipoprotein-associated phospholipase A(2) (Lp-PLA2). Areas of agreement: Elevated levels of serum CRP and Lp-PLA2 are associated with an increased risk of incident CHD events in both primary and secondary prevention studies across a wide range of age, gender and ethnic groups. Areas of controversy: The utility of inflammatory markers in predicting CHD risk when added to traditional risk factors is under debate. They are most useful in subjects in the intermediate-risk category. Growing points: Treatment with a statin in subjects with elevated CRP but without hyperlipidemia can reduce the risk of CHD. Areas timely for developing research: Extensive research is under way to identify additional novel serum markers with higher specificity for coronary artery plaque inflammation. Specific inhibitors against vascular inflammation in combination with medications to lower low-density lipoprotein cholesterol, i.e. statins, may help prevent cardiovascular events in the future.