Clinical implications of inflammation for cardiovascular primary prevention.

While many questions remain unanswered in this challenging arena, the emerging status of biomarkers of inflammation provides an excellent illustration of how application of basic and clinical science of inflammation can lead to advances in clinical care. Yet we need to do better. We need to improve the number needed to treat. We should strive for further refinements in risk prediction to individualize interventions. Imaging and genetic biomarkers will likely find their place in clinical practice alongside traditional risk factors and biomarkers of inflammation in the years to come. We must aim to assure that individuals targeted for statin therapy do not lessen their adherence to a healthy lifestyle, believing that they enjoy pharmacological protection from unhealthy behaviours. At the other extreme, we need to counsel carefully certain patients to avoid creating a cohort of 'cardiac neurotics' with above median high-sensitivity C-reactive protein readings. We need to understand more about the mechanisms and clinical significance of unwanted actions of statins, including dysglycaemia. We need to devise measures to optimize lifestyle change at both a medical and societal level. For our individual patients, implementation of sustained lifestyle change has proved very challenging in practice, given the multiplicity of behaviours that require vigilance. The clinical use of biomarkers of inflammation may provide the practitioner with a tool to help gauge residual risk, and chart a course for its optimal management.