Información del artículo
La proteína C-reactiva (PCR), un marcador sensible de inflamación, es un predictor independiente de enfermedad cardiovascular futura (ECV), que es una de las principales causas de muerte en todo el mundo. El papel de la inflamación en esta entidad ha sido bien documentado en la última década, y se ha demostrado inflamación en todas las fases de la aterosclerosis, desde el inicio y el crecimiento, hasta la ruptura de la placa. La PCR es una proteína de fase aguda, altamente sensible como marcador de inflamación general. En estudios experimentales, se ha determinado la presencia de PCR en arterias que presentan lesiones ateroscleróticas. También se ha demostrado que, en forma directa, la PCR induce la producción de otras células inflamatorias y que disminuye la expresión de la óxido nítrico sintetasa. Es decir, desde el punto de vista biológico, la PCR participa en el proceso aterogénico. En adultos, la PCR, detectada con técnicas ultrasensibles (PCRus), se asocia con los factores de riesgo tradicionales y su concentración predice eventos cardiovasculares.
Palabras clave:
proteína C reactiva
factores de riesgo
adiposidad
obesidad
C-reactive protein (CRP), a sensitive marker of inflammation is an independent predictor of future cardiovascular disease (CVD), which is one of the main causes of death worldwide. The role of inflammation in cardiovascular disease has been well documented in the last decade, and inflammation has been demonstrated in all stages of atherosclerosis, from its beginning and growth to the plaque rupture. CRP is an acute phase protein, highly sensitive as a marker of general inflammation. The presence of CRP has been determined in experimental studies in arteries with atherosclerotic lesions. It has been demonstrated as well that CRP induces directly the production of other inflammatory cells and decreases the expression of nitric oxide synthase. This means that from the biological standpoint CRP takes part in the atherogenic process. In adults, CRP detected through high sensitive CRP-test (hs-CRP) is associated to traditional risk factors and its concentration predicts cardiovascular events.
Key words:
C-reactive protein
risk factors
adiposity
obesity
El Texto completo está disponible en PDF
Bibliografía
[1.]
J. Danesh, J.G. Wheeler, G.M. Hirschfield, et al.
C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease.
N Engl J Med, 350 (2004), pp. 1387-1397
[2.]
P.M. Ridker.
Clinical application of C-reactive protein for cardiovascular disease detection and prevention.
Circulation, 107 (2003), pp. 363-369
[3.]
T.A. Pearson, G.A. Mensah, R.W. Alexander, J.L. Anderson, R.O.I. Cannon, M. Criqui, et al.
Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association.
Circulation, 107 (2003), pp. 499-511
[4.]
U.N. Khot, M.B. Khot, C.T. Bajzer, S.K. Sapp, E.M. Ohman, S.J. Brener, et al.
Prevalence of conventional risk factors in patients with coronary heart disease.
JAMA, 290 (2003), pp. 898-904
[5.]
P. Greenland, S.C. Smith Jr., S.M. Grundy.
Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests.
Circulation, 104 (2001), pp. 1863-1867
[6.]
R.S. Vasan.
Biomarkers of cardiovascular disease: molecular basis and practical considerations.
Circulation, 113 (2006), pp. 2335-2362
[7.]
W. Koenig, N. Khuseyinova.
Biomarkers of atherosclerotic plaque instability and rupture.
Arterioscler Thromb Vasc Biol, 27 (2007), pp. 15-26
[8.]
B. Zethelius, L. Berglund, J. Sundstro'm, E. Ingelsson, S. Basu, A. Larsson, et al.
Use of multiple biomarkers to improve the prediction of death from cardiovascular causes.
N Engl J Med, 358 (2008), pp. 2107-2116
[9.]
P.M. Ridker, E. Danielson, F.A.H. Fonseca, J. Genest, A.M. Gotto, J.J.P. Kastelein, on behalf of the JUPITER Trial Study Group, et al.
Rosuvastain for vascular prevention among men and women with elevated C-reactive protein.
N Engl J Med, 359 (2008), pp. 2195-2207
[10.]
P.M. Ridker, N. Rifai, M.J. Stampfer, et al.
Plasma concentration of interleukin-6 and the risk of future myocardial infarction among apparently healthy men.
Circulation, 101 (2000), pp. 1767-1772
[11.]
M. Mayr, S. Kiechl, J. Willeit, G. Wick, Q. Xu.
Infections, immunity, and atherosclerosis: associations of antibodies to Chlamydia pneumoniae, Helicobacter pylori, and Cytomegalovirus with immune reactions to heat-shock protein 60 and carotid or femoral atherosclerosis.
Circulation, 102 (2002), pp. 833-839
[12.]
D.H. Solomon, E.W. Karlson, E.B. Rimm, et al.
Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis.
Circulation, 107 (2003), pp. 1303-1307
[13.]
J.E. Salmon, M.J. Roman.
Accelerated atherosclerosis in systemic lupus erythematosus: implications for patient management.
Curr Opin Rheumatol, 13 (2002), pp. 341-344
[14.]
P. Libby, P. Ridker, A. Maseri.
Inflammation and atherosclerosis.
Circulation, 105 (2002), pp. 1135-1143
[15.]
J. Muntaner, J. Badimon, A. Piredda.
Placa y sangre vulnerable.
Rev CONAREC, 86 (2006), pp. 176-182
[16.]
A. Burke, R. Virmani.
Pathophysiology of acute myocardial infarction.
Med Clin North Am, 91 (2007), pp. 553-572
[17.]
E. Amstrong, D. Morrow, M. Sabatine.
Inflammatory biomarkers in acute coronary syndromes I: Introduction and cytokines.
Circulation, 113 (2006), pp. e72-e75
[18.]
M.B. Pepys, G.M. Hirschfield.
C-reactive protein: a critical update.
J Clin Invest, 111 (2003), pp. 1805-1812
[19.]
N. Rifai, P.M. Ridker.
High-sensitivity C-reactive protein: a novel and promising marker of coronary heart disease.
Clin Chem, 47 (2001), pp. 403-411
[20.]
D.G. Hackam, S.S. Anand.
Emerging risk factors for atherosclerotic vascular disease. A critical review of the evidence.
JAMA, 290 (2003), pp. 932-940
[21.]
J. Danesh, P. Whincup, M. Walker, L. Lennon, A. Thomson, P. Appleby, et al.
Low grade inflammation and coronary heart disease: prospective study and updated metaanalyses.
BMJ, 321 (2000), pp. 199-204
[22.]
L. Amezcua-Guerra, R. Springall, R. Bojalil.
C-reactive protein: cardiovascular issues of an acute-phase protein.
Arch Cardiol Mex, 77 (2007), pp. 58-66
[23.]
T.A. Pearson, G.A. Mensah, R.W. Alexander, J.L. Anderson, R.O.I. Cannon, M. Criqui, et al.
Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association.
Circulation, 107 (2003), pp. 499-511
[24.]
M.K. Chang, C.J. Binder, M. Torzewski, J.L. Witztum.
C-reactive protein binds to both oxidized LDL and apoptotic cells through recognition of a common ligand: phosphorylcholine of oxidized phospholipids.
Proc Natl Acad Sci USA, 99 (2002), pp. 13043-13048
[25.]
T.P. Zwaka, V. Hombach, J. Torzewski.
C-reactive protein mediated low density lipoprotein uptake by macrophages: implications for atherosclerosis.
Circulation, 103 (2001), pp. 1194-1197
[26.]
S. Verma, C.H. Wang, S.H. Li, et al.
A self-fulfilling prophecy: C-reactive protein attenuates nitric oxide production and inhibits angiogenesis.
Circulation., 106 (2002), pp. 913-919
[27.]
V. Pasceri, J.T. Willerson, E.T. Yeh.
Direct proinflammatory effect of C-reactive protein on human endothelial cells.
Circulation, 102 (2000), pp. 2165-2168
[28.]
V. Pasceri, J. Chang, J.T. Willerson, et al.
Modulation of C-reactive protein-mediated monocyte chemoattractant protein-1 induction in human endothelial cells by antiatherosclerosis drugs.
Circulation, 103 (2001), pp. 2531-2534
[29.]
C.H. Wang, S.H. Li, R. Weisel, et al.
C-reactive protein upregulates angiotensin type 1 receptors in vascular smooth muscle cells.
Circulation, 107 (2003), pp. 1783-1789
[30.]
B.R. Clapp, G.M. Hirschfield, C. Storry, J.R. Gallimore, R.P. Stidwill, M. Singer, et al.
Inflammation and endothelial function: direct vascular effects of human C-reactive protein on nitric oxide bioavailability.
Circulation, 111 (2005), pp. 1530-1536
[31.]
I. Jialal, S. Devaraj, S.K. Venugopal.
C-reactive protein: risk marker or mediator in atherothrombosis?.
Hypertension, 44 (2004), pp. 6
[32.]
T.N. Williams, C.X. Zhang, B.A. Game, Y. Huang.
C-reactive protein stimulates MMP- 1 expression in U937 histiocytes through FcgRII and extracelular signal-regulated kinase pathway: An implication of CRP involvement in plaque destabilization.
Arterioscler Thromb Vasc Biol, 24 (2004), pp. 61-66
[33.]
N. Ouchi, S. Kihara, T. Funahashi, et al.
Reciprocal association of C-reactive protein with adiponectin in blood stream and adipose tissue.
Circulation, 107 (2003), pp. 671-677
[34.]
A. Festa, R. D’Agostino, G. Howard, et al.
Chronic subclinical inflammation as part of the insulin resistance syndrome The Insulin Resistance Atherosclerosis Study (IRAS).
Circulation, 102 (2000), pp. 42-47
[35.]
T. Tracey McLaughlin, F. Abbasi, C. Lamendola, et al.
Differentiation between obesity and insulin resistance in the association with C-reactive protein.
Circulation, 106 (2002), pp. 2908-2913
[36.]
T.A. Pearson, G.A. Mensah, R.W. Alexander, J.L. Anderson, R.O. Cannon, M. Criqui, et al.
Markers of inflammation and cardiovascular disease: application to clinical and public health practice. A statement for health care professionals from the Centers for Disease Control and Prevention and the American Heart Association.
Circulation, 107 (2003), pp. 499-511
[37.]
P. López-Jaramillo, L.P. Pradilla, V.R. Castillo, V. Lahera.
Socioeconomic pathology as a cause of regional differences in the prevalence of metabolic syndrome and pregnancy-induced hypertension.
Rev Esp Cardiol, 60 (2007), pp. 168-178
[38.]
P. López-Jaramillo, E. Herrera, R. García, P.A. Camacho, V. Castillo.
Relationship of body mass index C-reactive protein and blood pressure in a hispanic pediatric population.
Am J Hypertens, 21 (2008), pp. 527-532
[39.]
R.G. García, M. Pérez, R. Maas, E. Schwedhelm, R.H. Böger, P. López-Jaramillo.
Plasma Concentrations of Asymmetric Dimethylarginine (ADMA) in Metabolic Syndrome.
Int J Cardiol, 122 (2007), pp. 176-178
[40.]
P. López-Jaramillo, L.P. Pradilla, V.R. Castillo, et al.
Socioeconomic pathology as a cause of regional differences in the prevalence of metabolic syndrome and pregnancy-induced hypertension.
Rev Esp Cardiol, 60 (2007), pp. 168-178
[41.]
S. Tsimikas, J.T. Willerson, P.M. Ridker.
C-reactive protein and other emerging blood biomarkers to optimize risk stratification of vulnerable patients.
J Am Coll Cardiol, 47 (2006), pp. 19-31
[42.]
J.P. Casas, T. Shah, A.D. Hingorani, J. Danesh, M.B. Pepys.
C-reactive protein and coronary heart disease: a critical review.
J Intern Med, 264 (2008), pp. 295-314
Copyright © 2011. Sociedad Colombiana de Cardiología y Cirugía Cardiovascular