International Task Force for Prevention of
Coronary Heart Disease
CORONARY HEART DISEASE: REDUCING THE RISK
2.4.1 Parameters of inflammation
Atherosclerosis bears many hallmarks of an inflammatory process. Plasma levels of several acute phase reactants such as fibrinogen and C-reactive protein (CRP, both positive risk factors) and HDL-cholesterol (negative risk factor) are altered in patients suffering from CHD.
Plasma CRP is positively correlated with increased risk of CHD, even at levels below those indicating acute inflammation in clinical practice. Accurate measurement of such low levels to assess cardiovascular risk depends on sensitive tests which are not yet used in routine laboratories. Nor is it clear whether changes in acute phase reactants merely indicate non-specific inflammatory processes in the arterial wall or whether they reflect the presence of specific infections that induce or accelerate atherosclerosis. The latter possibility is supported by recent studies in which Chlamydia pneumoniae was detected in atherosclerotic plaques of coronary arteries but not in normal coronary arterial tissue; but it is unclear whether these intracellular bacteria are harmless concomitants or causal agents in atherosclerosis.