Risk factors versus inflammation in atherothrombotic disease.

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To the Editor: The article by Sampietro et al1 in the January 8, 2002, issue of Circulation is important because it points out that low levels of high-density lipoprotein (HDL) are associated with elevations of C-reactive protein (CRP), and that those patients with atherothrombotic disease (ATD) have higher CRP levels than do those without ATD. CRP levels correlate with the severity of ATD, and hence, the finding of lower CRP levels in controls (average HDL=52.1 mg/dL) than in patients (average HDL=30.2 mg/dL) at the same low-density lipoprotein (LDL) level (average 181.5 versus 186.3 mg/dL) provides direct evidence of the protective effect of HDL against ATD. It also provides direct proof that it is the ratio between LDL and HDL, rather than simple LDL or HDL levels, that is the best predictor of atherosclerosis. The conclusions of Sampietro et al1 and the accompanying editorial by Ridker,2 however, divert attention from this important finding to the general subject of inflammation of the arterial wall. This, I believe, is an error, because it diverts attention away from causal …