However, hs-CRP is also associated with similar increases in mortality from several cancers and lung indicating that its association with cardiovascular risk is not specific. On the basis of multiple prospective studies, hs-CRP was recommended for measurement limited to people with moderate risk for coronary disease (10% to 20% 10-year risk using the Framingham Risk Score) as an adjunct to global risk assessment to help guide the aggressiveness of risk factor Recent evidence indicates that elevated plasma levels of YKL-40, a product of lipid-laden macrophages, are associated with an increased risk of ischemic stroke indepen- dently of hs-CRP levels.845 The JUPITER study, a randomized trial of a statin versus placebo, was performed in people free of CVD with otherwise normal LDL cholesterol levels ( 130 mg/ dL) but with hs-CRP levels >2 mg/dL. The trial found a reduc- tion in cardiovascular end points, including stroke (RR, 0.52; The study design did not include similarly treated subjects with lower lev- els of hs-CRP. No data are available to determine the potential effects of other treatments such as aspirin in this population. Monitoring of hs-CRP has not been evaluated in randomized trials to determine whether it is useful in adjusting statin dose in patients who might be considered for treatment, nor has its cost-effectiveness for population screening been assessed. This is also true of the other markers of inflammation. Another way to evaluate the role of inflammation as a risk factor for stroke is to examine the incidence of vascular dis- ease in people with systemic chronic inflammatory diseases such as rheumatoid arthritis (RA) and SLE. 