Clinical perspective on C-reactive protein in prognostication of major adverse cardiac events in the elderly with established coronary heart disease

The systemic response to tissue injury, regardless of cause is characterized by a cytokine-mediated alteration in the hepatic synthesis of a number of different plasma proteins, known collectively as 'acute phase reactants'. These proteins include C-reactive protein, serum amyloid A protein, alpha 1 glycoprotein, ceruloplasmin, alpha macroglobulins, comple-ment components (C1-C4, factor B, C9, Cll), alphal antitrypsin, alphal antichymotrypsin, fibrinogen, prothrombin, factor VDI, plasminogen, haptoglobin, ferritin, immunoglobu-lins and lipoproteins. The initiation of the acute phase response is linked to the production of hormone-like polypeptide me-diators now called cytokines, namedly, interleukin l(IL-l), tumor necrosis factor, interferon gamma, interleukin 6 (IL-6), leukemia inhibitory factor, ciliary neurotropic factor, oncostatin M, and interleukin 11 (IL-11).