C-reactive protein to identify early risk for development of calcific aortic stenosis: right marker? Wrong time?

alcific aortic valve disease is the most common acquired alvular disorder in developed countries. Disease involveent of the trileaflet aortic valve spans the spectrum from aortic sclerosis,” characterized by valve thickening, fibrosis, nd microscopic calcification without left ventricular outow obstruction, to frank “aortic stenosis,” characterized by ore severe involvement with limitation of valve opening 1). Aortic sclerosis is present in more than 25% of individals over the age of 65 years and aortic stenosis in 2%, with he prevalence of both manifestations dramatically increasng with more advanced age (1–3). The dynamic and nflammatory nature of calcific aortic stenosis has been well ppreciated in recent years, and many pathobiologic features f calcific aortic valve disease exhibit striking similarity to oronary atherosclerosis. C-reactive protein (CRP), which as been an extremely useful predictive biomarker of the nflammatory process and prognosis of atherosclerosis (4), is ncreased in subsets of patients with calcific aortic stenosis, nd this has led to the hope that CRP could be used as well o identify those patients likely to progress or develop severe alcific aortic stenosis. The article by Novaro et al. (5) in this ssue of the Journal sheds new and interesting light on some imitations of that hope.