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The Role of Inflammation for Heart Disease Risk Cannot Be Determined by Correlations Between C-Reactive Protein and Risk Factors—Reply
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In reply
Engström raises the question whether "elevated CRP level is attributable to CHD risk factors" or whether "CHD risk factors are attributable to low-grade inflammation."1(p2063) If elevated CRP level is attributable to CHD risk factors, one would predict that therapies aimed at improving the CHD risk profile would also favorably influence CRP levels. In fact, this has been well documented following treatment of obesity, diabetes mellitus, hypertension, and dyslipidemia.2-4 In contrast, it is considerably less plausible to believe that CHD risk factors such as cigarette smoking or physical inactivity would be "caused" by inflammation. Moreover, the concept that "CRP measurements may have limited clinical utility as a screening tool beyond other known risk factors"1(p2063) gained further support recently when the Framingham Heart Study found that CRP level added no additional value in predicting CHD events beyond that derived from traditional risk factors.5 In view of the aforementioned, we agree . . . [Full Text of this Article]
AUTHOR INFORMATION
Michael Miller, MD;
Stephen Havas, MD, MPH
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