In the latest issue of the Journal of Internal Medicine, Casas et al. reviewed the role of C-reactive protein (CRP) in the pathophysiology of coronary heart disease (CHD). After summarizing the biochemistry of CRP (structure, ligand binding, functions, and synthesis), the authors reviewed the literature on the potential role of CRP as a possible CHD risk predictor. They highlighted the fact that most studies on the topic found an association between CRP and long-term CHD risk in general populations. However, since many other CHD risk factors are closely associated with variations in CRP, the question arises as to whether CRP is an “independent” CHD risk predictor. Casas et al. also reviewed the rather controversial literature on experimental or in vivo studies that have sought to establish the biological pathways through which CRP might be atherogenic. They concluded that although in vivo studies have supported an atherogenic role for CRP, the question of whether moderately elevated CRP levels predict CHD risk may be addressed by studying the effect of a CRP inhibitor and by pooling analyses of data from prospective studies on circulating CRP and CRP gene variants.
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