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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2000;20:901.)
© 2000 American Heart Association, Inc.

Editorial

The Role of Inflammation in Cardiovascular Disease

Lewis H. Kuller; Russell P. Tracy

From the University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pa (L.H.K.), and the University of Vermont–Pathology, Colchester Research Facility, Colchester (R.R.P.).

Correspondence to Lewis H. Kuller, MD, DrPH, University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, 130 DeSoto St, Pittsburgh, PA 15261. E-mail kuller@imap.pitt.edu

Key Words: Editorals • inflammation • stroke • C-reactive protein • cytokines

The article in this issue by Gussekloo et al,¹ "C-reactive protein is a strong but nonspecific risk factor of fatal stroke in elderly persons," demonstrates 2 important points. First, for maximum predictive value, a variable such as C-reactive protein (CRP) should preferably be a risk factor for a specific outcome rather than for a broad range of unrelated outcomes such as stroke, coronary heart disease, cancer, and total mortality. There are some risk factors such as cigarette smoking and radiation exposure that are associated with many different outcomes, and future work may show that CRP falls into this important category. However, in general, the specificity of an association is an important component, often reflecting a causal relationship. These investigators determined that elevated CRP is not specific for stroke or other cardiovascular disease mortality. This is not surprising, since an elevated CRP level is related to inflammation,² and increased inflammation will be noted for many diseases, such as cancer, cardiovascular disease, infection, connective tissue diseases, injury, etc.

Second, the relationship between CRP and stroke or other causes of death was time dependent; ie, the shorter the time between the measurement of CRP and death, the higher were the levels of CRP. This finding is consistent with results in older individuals from the Cardiovascular Health Study³ but not with results in middle-aged or younger individuals, such as the follow-up of the Multiple Risk Factor Intervention Trial⁴ or the Physicians’ Health Study.⁵ In older individuals the prevalence of subclinical disease, ie, cardiovascular disease, . . . [Full Text of this Article]

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