C-REAKTIVNI PROTEIN U PROCJENI KARDIOVASKULARNOG RIZIKA

Damir Fabijanić, Marko Banić, Duško Kardum

Upala ima središnju ulogu u pokretanju, napredovanju i destabilizairanju ateroma. Stoga su, radi poboljšanja procjene ukupnoga kardiovaskularnog rizika, brojna istraživanja usredotočena na biljege upale,  napose na visokoosjetljivi C-raktivni protein (hs-CRP). Pokazano je da vrijednost hs-CRP-a iznad 3mg/L upućuju na povećan rizik od pojave kardiovaskularnih događaja u zdravih osoba, a također na povećan rizik od nepovoljnih događaja u bolesnika sa stabilnom i nestabilnom anginom, akutnim infrktom miokarda te u bolesnika koje se podvravaju zahvatima revaskularizacije  koronarnih arterija. Nadalje, razni farmakološki (npr. primjena aspirina, statina, tinopiridina) i nefarmakološki postupci ( npr. smanjenje tjelesne mase, prestanak pušenja, tjelovježba) koji dokazano smanjuju kardiovaskularni rizik, ujedno smanjuju razinu hs-CRP-a. Stoga razije hs-CRP-a mogu biti korisne pri izboru liječenja u primarnoj i sekundarnoj prevenciji kardiovaskularnih bolesti. U ovom pregledu razmatra se uloga hs-CRP-a u patogenezi ateroskleroze te njegova primjena u svakodnevnom kliničkom radu uključujući ulogu hs-CRP-a u prepoznavanju osoba s povećanim kardiovaskularnim rizikom, praćenja aktivnosti koronarne bolesti i procjeni učinka liječenja na upalnu komponentu kardiovaskularnih bolesnika.

Summary. Inflammation plays a central role in the initiation, progression and destabilization of atheroma. In an attempt to improve global cardiovascular risk assessment considerable research has focused on inflammatory markers, particularly high sensitive C-reactive protein (hs-CRP). It has been reported that hs-CRP levels more than 3 mg/L identify increased risk of initial cardiovascular events in healthy individuals and also increased risk of adverse events in patients with stable and unstable angina, acute myocardial infarction, and in patients undergoing coronary revascularization procedures. Further- more, several pharmacologic (eg. aspirin, statins, tienopiridins) and lifestyle interventions (eg. weight loss, smoking cessation, regular exercise) known to reduce cardiovascular events rates have also been shown to lower levels of hs-CRP. Therefore, hs-CRP levels may also prove useful in targeting therapy for primary and secondary prevention. This review discusses the role of hs-CRP in the pathogenesis of atherosclerosis and its application in every day clinical practice, includ- ing the role of hs-CRP in identification of high-risk individuals, monitoring of the coronary artery disease activity, and assessment of therapeutic effect on the inflamatory component of the cardiovascular process.