Inflammatory pathways in atherosclerosis and acute coronary syndromes

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Abstract

Evidence from a broad range of studies demonstrates that atherosclerosis is a chronic disease that, from its origins to its ultimate complications, involves inflammatory cells (T cells, monocytes, macrophages), inflammatory proteins (cytokines, chemokines), and inflammatory responses from vascular cells (endothelial cell expression of adhesion molecules). Investigators have identified a variety of proteins whose levels might predict cardiovascular risk. Of these candidates, C-reactive protein, tumor necrosis factor-α, and interleukin-6 have been most widely studied. There is also the prospect of inflammation as a therapeutic target, with investigators currently debating to what extent the decrease in cardiovascular risk seen with statins, angiotensin-converting enzyme inhibitors, and peroxisome proliferator-activated receptor ligands derives from changes in inflammatory parameters. These advances in basic and clinical science have placed us on a threshold of a new era in cardiovascular medicine.

Section snippets

Inflammation in atherosclerosis: evidence from vascular biology

Insight into atherosclerosis and the pathogenesis of its sequelae, such as myocardial infarction (MI), have evolved dramatically over the 100 years since researchers first demonstrated that cholesterol-rich diets induce atherosclerosis in rabbits.1, 4 Today, it seems almost inconceivable that Aschoff and other early investigators5, 6 had to convince the medical establishment that atherosclerosis was not simply a degenerative disease confined to the elderly. Insight into the disease has advanced

Inflammation in clinical cardiology: the potential use of markers

The prospect that measures of nonspecific markers of chronic low-grade inflammation might predict the risk of future MI 10 or 20 years later, is a powerful one. A number of studies have identified a variety of proteins whose levels may predict cardiovascular risk (Figure 1). 44 Early studies found that markers of inflammation such as C-reactive protein (CRP) correlated with unstable angina pectoris in acute coronary syndromes.45, 46, 47 In the Physicians’ Health Study, Ridker et al48 found that

Inflammation and inflammatory markers in cardiovascular practice: future prospects

Despite the impressive gains in understanding atherosclerosis, many questions persist about the use of inflammatory markers in clinical practice.93 Although CRP levels are predictive in research settings, their use clinically remains to be fully defined.94 Many transitory states (eg, upper respiratory infection, subclinical infection, other medications) may alter CRP levels, making interpretation difficult. It is also unclear how to use CRP levels in the prospective management of patients on

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