Inflammation is a major factor in atherothrombotic disease. Levels of
high-sensitivity C-reactive protein (
hs-CRP), a marker of systemic
inflammation and a mediator of atherothrombotic disease, have been shown to correlate with
cardiovascular disease risk. Recent findings in 27,939 healthy women in the Women's Health Study indicate that
hs-CRP (1) is a stronger predictor of risk than
low-density lipoprotein (
LDL) cholesterol, (2) predicts elevated risk in subjects without overt
hyperlipidemia, and (3) adds prognostic information to risk scoring and
LDL cholesterol categories. Other data from this cohort show that
hs-CRP level adds prognostic information to the diagnosis of the
metabolic syndrome. Taken together with other data in men on the association of
hs-CRP with vascular risk, a strong argument is provided for screening in the primary prevention population. With regard to potential treatment,
statins have been found to reduce
hs-CRP levels, and data from
statin treatment trials raise the possibility that subjects with elevated
hs-CRP levels may derive greater benefit from treatment than do patients without elevated
hs-CRP. The Justification for the Use of
Statins in Primary Prevention: an Intervention Trial Evaluating
Rosuvastatin (JUPITER) trial is planned to examine the effects of
rosuvastatin treatment in preventing cardiovascular events in 15,000 healthy subjects with elevated
hs-CRP levels in the absence of overt
hyperlipidemia.