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Inflammation in Systemic Vascular Disease:
What can we learn?
  • Paul M Ridker, MD
  • Eugene Braunwald Professor of Medicine
  • Harvard Medical School
  • Director, Center for Cardiovascular Disease Prevention
  • Brigham and Women’s Hospital, Boston, MA
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Pro-Inflammatory Pathways
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hs-CRP and Risk of Future MI and CVA in Apparently Healthy Men
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hs-CRP and Risk of Future Cardiovascular Events in Apparently Healthy Women:
Low-Risk Subgroups
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Novel Risk Factors as Predictors of Peripheral Arterial Disease
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A Direct Comparison of  LDL-C        and CRP        in the Prediction of First Ever Cardiovascular Events Among 27,939 Women
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CRP Adds Prognostic Information at all Levels of LDL-C and at all Levels of the Framingham Risk Score
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hsCRP Adds Prognostic Information Beyond the Framingham Risk Score in ALL Major Cohorts Evaluated
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Clinical Predictive Value of Very Low as Well as Very High Levels of hsCRP
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Combined Use of CT Calcium Scores and CRP in the Prediction of Cardiovascular Events:
South Bay Heart Watch
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hsCRP Predicts Onset of First Ever Stroke / TIA
Independent of Other Risk factors:
The Framingham Heart Study
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hsCRP and Progression of Cerebral Small-Vessel Disease:
The Rotterdam Scan Study
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hsCRP and SAA Predict Short-Term Progression of
Atherosclerosis Lesions in Human Carotid Arteries
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hsCRP and Subsequent Development of Vascular Dementia: The Honolulu-Asia Aging Study
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CRP, IL-6 and the Risk for Developing
Type-2 Diabetes in the Women’s Health Study
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hsCRP and the Development of Metabolic Syndrome or Diabetes: 11 Year follow-up Kuopio, Finland
Laaksonen et al, Diabetolgia 2004;47:1403-1410
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Moving Toward an hs-CRP Modified Definition of Metabolic Syndrome
  • Waist circumference > 102 cm (men), > 88 cm (women)
  • TG > 150 mg/dL or HDL < 40 mg/dL (men), < 50 mg/dL (women)
  • SBP > 130 mm Hg or DBP > 85 mm Hg
  • FPG > 100 mg/dL
  • hsCRP > 3 mg/L
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Prevalence of Conventional Risk Factors in Patients with Coronary Heart Disease (N = 87,869)
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Moving Toward an hs-CRP Modified Framingham Risk Score
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hsCRP Enters Global Risk Prediction Models Before TC, HDL, and LDLC
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The Clinical Issue: Comparison of Observed vs Expected Risks With and Without hsCRP
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Therapeutic Implications: hs-CRP
  • Exercise
  • Weight loss
  • Smoking Cessation
  • Blood pressure control
  • Diet / Glucose control
  • Lipid Reduction
  • Targeted anti-inflammatory therapies
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Anti-Inflammatory Effects of Statins
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Inflammation, Statin Therapy, and hsCRP: Initial Observations
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First Acute Major Coronary Event : AFCAPS/TexCAPS
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REVERSAL: Regression of Atherosclerosis On Statin Therapy Occurs Primarily Among Those with Both LDL and CRP Reduction
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Death through 2 yrs
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Does Lowering hsCRP Correlate with Improved Vascular Risk?
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Markers of Inflammation in the Prediction of Cardiovascular Disease in Women
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Direct Evidence of Proatherogenic Effects of CRP?
Aortic Atherosclerotic Lesion Size is Increased in Male CRPtg+ Apo-E Deficient Mice
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Association of Common CRP SNPs with Plasma CRP Levels
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Can we directly inhibit CRP function?
  • Anti-sense drug technologies
  •   (ISIS Pharmaceuticals)
  • Celecade / Apoptosis Approaches
  •   (Vasogen, Inc)
  • 1-6-bis(phosphocholine)-hexane
  • (Pentraxin Therapeutics)
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Nature April 27, 2006
Pepys et al Nature 2006;440:1217-1221

Targeting C-reactive protein for the treatment of cardiovascular disease (1,6-bis(phosphocholine)-hexane)
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Inflammation in Pulmonary Arterial Hypertension
Dorfmuller, Perros, Balabanian, Humbert
Eur Respir J 2003;22:358-363
  • Does Inflammation play a role in some forms of PH?
  • Monocrotaline-induced PH
  • Scleroderma, lupus, mixed connective tissue disease
  • HIV
  • POEMS (plasma cell dyscrasia, organomegaly, endocrinopathy, monoclonal protein, skin changes)