Update on C-reactive protein as a risk marker in cardiovascular disease.

Atherosclerosis is characterized by a nonspecific local inflammatory process, which is accompanied by a systemic response. A number of prospective studies have convincingly demonstrated a strong and independent association between even slightly elevated concentrations of systemic markers of inflammation, like C-reactive protein (CRP), and cardiovascular events in initially healthy subjects and in patients with manifest atherosclerosis. Increased concentrations of CRP were also associated with recurrent instability after discharge, and with early and late complications after percutaneous interventions, bypass operation, and in patients with end-stage renal disease. Recent data have strengthened the role for CRP testing in primary prevention, and potentially new indications like glucose disorders have emerged. In addition, new experimental data suggest that CRP may not only be a risk marker, but may be directly involved in the pathogenesis of atherothrombosis. Testing the "inflammation hypothesis" now represents an important goal for clinical research of atherosclerosis.