Hypertension. 2004;44:6-11
Published online before print May 17, 2004, doi: 10.1161/01.HYP.0000130484.20501.df
Published online before print May 17, 2004, doi: 10.1161/01.HYP.0000130484.20501.df
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(Hypertension. 2004;44:6.)
© 2004 American Heart Association, Inc.
Brief Reviews |
C-Reactive Protein: Risk Marker or Mediator in Atherothrombosis?
From the Laboratory for Atherosclerosis and Metabolic Research, UC Davis Medical Center, Sacramento, Calif.
Correspondence to Dr. Ishwarlal Jialal, Director of the Laboratory for Atherosclerosis and Metabolic Research, 4635 Second Ave, Res 1 Bldg, Rm 3000, Sacramento CA 95817. E-mail ishwarlal.jialal{at}ucdmc.ucdavis.edu
Inflammation appears to be pivotal in all phases of atherosclerosis from the fatty streak lesion to acute coronary syndromes. An important downstream marker of inflammation is C-reactive protein (CRP). Numerous studies have shown that CRP levels predict cardiovascular disease in apparently healthy individuals. This has resulted in a position statement recommending cutoff levels of CRP <1.0, 1.0 to 3.0, and >3.0 mg/L equating to low, average, and high risk for subsequent cardiovascular disease. More interestingly, much in vitro data have now emerged in support of a role for CRP in atherogenesis. To date, studies largely in endothelial cells, but also in monocyte-macrophages and vascular smooth muscle cells, support a role for CRP in atherogenesis. The proinflammatory, proatherogenic effects of CRP that have been documented in endothelial cells include the following: decreased nitric oxide and prostacyclin and increased endothelin-1, cell adhesion molecules, monocyte chemoattractant protein-1 and interleukin-8, and increased plasminogen activator inhibitor-1. In monocyte-macrophages, CRP induces tissue factor secretion, increases reactive oxygen species and proinflammatory cytokine release, promotes monocyte chemotaxis and adhesion, and increases oxidized low-density lipoprotein uptake. Also, CRP has been shown in vascular smooth muscle cells to increase inducible nitric oxide production, increase NF
b and mitogen-activated protein kinase activities, and, most importantly, upregulate angiotensin type-1 receptor resulting in increased reactive oxygen species and vascular smooth muscle cell proliferation. Future studies should be directed at delineating the molecular mechanisms for these important in vitro observations. Also, studies should be directed at confirming these findings in animal models and other systems as proof of concept. In conclusion, CRP is a risk marker for cardiovascular disease and, based on future studies, could emerge as a mediator in atherogenesis.
Key Words: endothelium • macrophages • atherosclerosis
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