Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice

Atherosclerosis is, at its root, an inflammatory disease — plaque is not simply cholesterol stacking up in a pipe, but an active immune process in the artery wall. This 2003 CDC/AHA statement was the first formal attempt to turn that biological insight into a blood test a clinician could order.

Out of a crowded field of inflammatory markers, the panel chose one for the clinic: high-sensitivity C-reactive protein (hs-CRP). The statement spelled out how to measure it, when to measure it, and how to interpret it — establishing the now-familiar tiers of cardiovascular risk and recommending it as an optional addition for patients whose risk by traditional factors was unclear. It is the document that moved hs-CRP from research laboratory to routine availability.

The honest caveat, which the authors stated plainly, is the difference between a marker and a target. The evidence that hs-CRP predicts events was strong; the evidence that screening for it and acting on the result changes outcomes was not yet randomized at the time. The data also came almost entirely from white North American and European populations.

We rate the evidence strong as a foundational consensus. It was rigorous and influential — the parent document of two decades of inflammation-focused cardiovascular research — even as the field still debates exactly how much an inflammatory marker should change what a clinician does.