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Vol. LVII, No. 21
October 21, 2005

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Astute Clinician Lecture Addresses Heart Disease Risk

On the front page...

"Inflammation, CRP and Cardiovascular Risk: Is It Time to Change the Framingham Risk Score?" is the subject of the 2005 Astute Clinician Lecture, scheduled for Wednesday, Nov. 2 at 3 p.m. in Masur Auditorium, Bldg. 10.

The speaker is Dr. Paul Ridker, Eugene Braunwald professor of medicine at Harvard Medical School and director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital in Boston.


A graduate of Brown University, Harvard Medical School and the Harvard School of Public Health, Ridker's work on inflammation and C-reactive protein (CRP) led to the first set of federal guidelines advocating CRP evaluation to detect heart disease.

  Dr. Paul Ridker

CRP is a highly sensitive marker of inflammation and can predict risk of developing a future heart attack or stroke. High levels of CRP have been found to more accurately predict heart disease than cholesterol, the most commonly used predictor of heart disease.

In multiple studies evaluating men and women, Ridker's work has consistently found that those with elevated baseline levels of CRP are at two-to three-fold increased risk of future heart disease and stroke, even after taking into account all traditional risk factors used in the Framingham Risk Score.

"In fact, those with high levels of CRP and low levels of cholesterol are at substantially higher risk than those with high levels of cholesterol and low levels of CRP," said Ridker. "This data validates the concept that inflammation is crucial to atherosclerosis."

Ridker's group also discovered that the widely prescribed "statin" drugs not only lower cholesterol, but also lower CRP levels, and that both of these factors are important for determining drug efficacy.

"This was a major challenge for heart disease screening," said Ridker. "The medical profession was relying predominantly on cholesterol levels to both predict and monitor heart disease risk. People with high CRP levels were outside the federal screening guidelines; yet, for many, their risk is actually higher than people inside the former guidelines."

The study echoed what Ridker and many other doctors had been observing for years. For every patient with high cholesterol and plaque-clogged arteries, there was one with low cholesterol who nonetheless developed a heart attack or stroke. In addition to the development of new guidelines for heart-disease risk, the finding led to more widespread use of novel preventive therapies.

Ridker's research is supported by multiple NHLBI grants, and by a Distinguished Clinical Scientist Award from the Doris Duke Charitable Foundation. Time magazine honored Ridker as one of America's 10 best researchers in science and medicine in 2001.

The Astute Clinician Lecture was established through a gift from Haruko and Dr. Robert W. Miller. It honors a U.S. scientist who has observed an unusual clinical occurrence, and by investigating it, has opened an important new avenue of research.

The lecture is an NIH Director's Wednesday Afternoon Lecture Series event. For information and for reasonable accommodation, contact Hilda Madine, (301) 594-5595.

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