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Laboratory for Atherosclerosis and Metabolic Research
University of California, Davis, Medical Center
Sacramento, CA 95817
E-mail: sdevaraj{at}ucdavis.edu
C-Reactive Protein and Cardiovascular Disease, edited by Drs Paul Ridker and Nader Rifai from the Harvard Medical School and with a foreword by Dr Eugene Braunwald, is a timely and interesting review of the prominent role played by inflammation in atherosclerosis. It focuses on the prototypic marker of inflammation in man—ie, C-reactive protein (CRP)—and its role as a novel marker of cardiovascular disease risk.
Pathologists, right from Virchow, have recognized the contribution of inflammation to the genesis of the atherosclerotic plaque, and CRP was identified by Tillet and Francis in the 1930s in the serum of patients with pneumonia. The development of a high-sensitivity assay for CRP enabled its measurement in different populations. Over the last 20 y, several prospective clinical studies from different parts of the world and in different populations have established CRP as an important indicator for cardiovascular disease risk. In addition, recent evidence supports a role for CRP in mediating atherothrombosis.
This book addresses several topics of current interest in inflammation, CRP, and atherosclerosis in 24 chapters grouped into 6 sections, written by different leading scientists in the field. In the first section, written by Ridker and Rifai, the utility of CRP measurements in the primary prevention of myocardial infarction and stroke is discussed. The next section, which covers inflammation and atherogenesis, focuses the attention of the reader on the pathobiology of atherosclerosis and discusses new work on the role of CRP as not only a risk marker but also a possible mediator in atherogenesis.
The third and fourth sections of the book deal with the utility of measuring CRP concentrations in persons with cardiovascular disease and other conditions associated with premature atherosclerosis, such as hypertension, kidney disease, metabolic syndrome, and diabetes. The fifth section of the book provides a good summary of the role of environmental and genetic determinants of CRP in adults and also discusses the role of diet and adiposity in CRP concentrations. The sixth section details the effects of pharmacologic agents on CRP concentrations, including novel antiinflammatory therapy. This final section pertains to important preanalytic and analytic issues related to the laboratory evaluation of high-sensitivity CRP and its formal use in modern global prediction models designed to detect increased risk of cardiovascular disease, and the information contained here is very important reading for clinicians who aim to use CRP effectively in the clinical setting as a marker of cardiovascular disease risk.
C-Reactive Protein and Cardiovascular Disease thus provides an excellent review and is an invaluable resource for physicians who are interested in the prevention and treatment of heart disease. Although this book does not provide novel information on sources of CRP in the atheroma and does not discuss in detail the critical role of immunoglobin (Fc) receptors in mediating the biological and molecular effects of CRP and newer strategies to block CRP and atherothrombosis, we look forward to a sequel that can give us this information to make the book comprehensive and interesting to researchers and physicians.
ACKNOWLEDGMENTS
The author had no personal or financial conflict of interest with the authors or the subject of this book.