LONDON, September 11 (SPIS MedWire). Elevated levels of serum C-reactive protein (CRP) - indicative of systemic inflammation - are associated with a blunted systemic endothelial vasodilatation, report a team from Johann Wolfgang Goethe University in Frankfurt. Their findings, published in Circulation, add further credibility to the theory that the link between inflammation and cardiovascular risk is mediated by endothelial dysfunction. Fichtlschere et al measured forearm blood flow responses to acetylcholine (ACh) and sodium nitroprusside in 60 male patients with coronary artery disease. They found that the response to endothelium-dependent ACh was inversely correlated with CRP levels (p = 0.001). This association remained a statistically significant independent predictor of endothelial dysfunction, even after adjustment for traditional coronary risk factors. The team also found that normalization of elevated CRP levels was associated with a normalization of endothelium-mediated blood flow after three months. Patients in the lowest tertile of CRP levels were less likely to be diagnosed with acute coronary syndrome, and also had a significantly augmented response to ACh-induced vasodilatation. The team concluded, "These findings support the concept that alterations in endothelial cell function may provide a link between systemic inflammation and ischemic coronary events." They call for further studies to explore the mechanisms that underlie endothelial vascular dysfunction associated with systemic inflammation, and to establish whether a blunted endothelial vasoreactivity is an independent risk factor for coronary events "rather than a phenomenon of no pathological importance."