We thank our correspondents for pointing out the important and manifold research insights regarding the role of inflammatory processes in the development and progression of atherosclerosis. Measures of serum high-sensitivity C-reactive protein (hs-CRP) undoubtedly have particular importance as a cardiovascular risk marker. However, a causal role of hs-CRP remains uncertain (1). Likewise, the benefit of measuring hs-CRP in addition to classical risk factors as part of individual risk assessment remains uncertain. Individual cardiovascular risk assessment may be improved in certain subgroups (2). Ongoing randomized clinical trials will provide information on the therapeutic benefit of targeted anti-inflammatory treatment; these trials are focused less on hs-CRP rather than early pro-inflammatory cytokines (3). Against this background, it will in any case make sense to include standardized measures of inflammatory biomarkers, such as hs-CRP, in the monitoring of cardiovascular risk factors at the population level, and to analyze these markers in context with classical cardiovascular risk factors. Our analysis of time trends in cardiometabolic risk in Germany based on three survey periods was limited to available data on classical cardiovascular risk factors (4). Current in-depth analyses that include data from two survey periods so far (German National Health Interview and Examination Survey 1998 and German Health Interview and Examination Survey for Adults 2008–2011) take hs-CRP into consideration (Abstract: Truthmann et al; Gesundheitswesen 2016; 78–A47).

DOI: 10.3238/arztebl.2017.0212b

On behalf of the authors:

Dr. med. Christa Scheidt-Nave, M.P.H.

PD Dr. med. Hannelore Neuhauser, M.P.H.

Abteilung Epidemiologie und Gesundheitsmonitoring,

Robert Koch-Institut Berlin, scheidt-navec@rki.de

Conflict of interest statement
The authors of both contributions declare that no conflict of interest exists.

1.
C Reactive Protein Coronary Heart Disease Genetics Collaboration (CCGC), Wensley F, Gao P, Burgess S, et al.: Association between C reactive protein and coronary heart disease: mendelian randomisation analysis based on individual participant data. BMJ 2011; 342: d548. doi: 10.1136/bmj.d548 CrossRef
2.
Dallmeier D, Koenig W: Strategies for vascular disease prevention: the role of lipids and related markers including apolipoproteins, low-density lipoproteins (LDL)-particle size, high sensitivity C-reactive protein (hs-CRP), lipoprotein-associated phospholipase A2 (Lp-PLA2) and lipoprotein(a) (Lp(a)). Best Pract Res Clin Endocrinol Metab 2014; 28: 281–94 CrossRef MEDLINE
3.
Ridker PM: From C-reactive protein to interleukin-6 to interleukin-1: moving upstream to Identify novel targets for atheroprotection. Circ Res 2016; 118: 145–56 CrossRef MEDLINE PubMed Central
4.
Finger JD, Busch MA, Du Y, et al.: Time trends in cardiometabolic risk factors in adults—results from three nationwide German examination surveys from 1990–2011. Dtsch Arztebl Int 2016; 113: 712–9 VOLLTEXT
1. C Reactive Protein Coronary Heart Disease Genetics Collaboration (CCGC), Wensley F, Gao P, Burgess S, et al.: Association between C reactive protein and coronary heart disease: mendelian randomisation analysis based on individual participant data. BMJ 2011; 342: d548. doi: 10.1136/bmj.d548 CrossRef
2. Dallmeier D, Koenig W: Strategies for vascular disease prevention: the role of lipids and related markers including apolipoproteins, low-density lipoproteins (LDL)-particle size, high sensitivity C-reactive protein (hs-CRP), lipoprotein-associated phospholipase A2 (Lp-PLA2) and lipoprotein(a) (Lp(a)). Best Pract Res Clin Endocrinol Metab 2014; 28: 281–94 CrossRef MEDLINE
3. Ridker PM: From C-reactive protein to interleukin-6 to interleukin-1: moving upstream to Identify novel targets for atheroprotection. Circ Res 2016; 118: 145–56 CrossRef MEDLINE PubMed Central
4.Finger JD, Busch MA, Du Y, et al.: Time trends in cardiometabolic risk factors in adults—results from three nationwide German examination surveys from 1990–2011. Dtsch Arztebl Int 2016; 113: 712–9 VOLLTEXT

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