Pcr Y Aterosclerosis

TRABAJO DE PATOLOGÍA CLÍNICA
Grupo: 4B
Fecha:5/noviembre/2012

TEMA: Atherosclerotic Coronary Artery Disease: Usefulness of C-Reactive Protein for the Identification of the «Vulnerable» Plaque and the «Vulnerable» Patient
Accumulated evidence suggests that high-sensitivity CRP is a predictor of cardiovascular risk in patients with established heart disease and in apparently healthy persons.Indeed, it has recently been suggested that CRP is a more powerful predictor of risk than levels of low density lipoprotein cholesterol (LDL-C) and that it provides added prognostic information to the conventional Framingham score.1 Arterial inflammation and blood levels of CRP are lowered by several drugs, such as aspirin, reductase inhibitor 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG-CoA),angiotensin converting enzyme (ACE) inhibitors, thienopyridines, and peroxisome proliferator-activated receptor (PPAR) agonists, which reduce morbidity and mortality in patients with cardiovascular disease and in apparently healthy subjects. However, whether inhibition of the inflammation and the consequent reduction in CRP result in a reduction in clinical events is currently unknown. The benefit interms of mortality resulting from the use of statins or ACE inhibitors cannot be explained simply by their respective lipid lowering or antihypertensive effects; rather they appear to be at least partly mediated by their anti-inflammatory effects. The Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS), a primary prevention study in 5742 subjects at low to moderate risk ofdeveloping coronary artery events, showed treatment with lovastatin to be highly effective in reducing such events among subjects with baseline LDL-C values above 149 mg/dL (the median LDL-C distribution in the overall study population). However, treatment with lovastatin has also been shown to be just as effective at reducing coronary artery events in subjects with normal LDL-C values and highlevels of CRP.2 The results of this latter study are particularly interesting, not only because they confirm that raised levels of CRP predict cardiovascular risk and that the measurement of CRP together with a lipid workup improves the overall evaluation of risk, but also because they suggest that HMG-CoA reductase inhibitors are even effective in apparently healthy persons with nohypercholesterolemia but who have a tendency to develop cardiovascular events, as detected by raised CRP levels. Indeed, the recent clinical guidelines published by the American Heart Association/Centers for Disease Control and Prevention (AHA/CDC) consider the measurement of high-sensitivity CRP a class IIa recommendation in the stratification of the primary prevention of cardiovascular disease. This isespecially so in persons who are at moderate overall risk for coronary events (10%-20% at 10 years, according to the conventional Framingham score), for whom the physician needs additional information before deciding on diagnostic techniques, recommending a more aggressive modification in life-style, or starting cardioprotective therapy with such drugs as aspirin, statins, or ACE inhibitors.3
C-reactiveprotein is also a predictor of the short- and long-term recurrence of cardiovascular events and death in patients with acute coronary syndromes (ACS), and its prognostic capacity has even been shown independently of other risk markers, such as troponins or B-type natriuretic peptide.4 In this issue of Revista Española de Cardiología Sanchís et al5 analyze the relationship between high-sensitivityCRP, troponin I, and the angiographic complexity of the culprit lesion in 125 patients with non-ST segment elevation ACS and important single coronary vessel disease.5 The patients in this study with elevated CRP values had more thrombotic culprit lesions, more lesions with a TIMI flow <3 and elevated troponin I concentrations. Sanchís et al5 therefore suggest that the inflammatory activity of...