Markers of Inflammation and Rapid Coronary Artery Disease Progression in Patients With Stable Angina Pectoris

Abstract

Background-Both endothelial cell activation and macrophage activation play a significant role in atherogenesis and atheromatous plaque vulnerability and may determine rapid coronary artery disease (CAD) progression. We sought to assess the association between serum inflammatory markers and rapid CAD progression in patients with chronic stable angina pectoris. Methods and Results-We studied 124 chronic stable angina pectoris patients (84 men; mean age, 61Ϯ10 years) who were on a waiting list for coronary angioplasty for a mean time of 4.8Ϯ2.4 months. CAD progression was defined as Ն10% diameter reduction of a pre-existing stenosis Ն50%, Ն30% diameter reduction of a stenosis Ͻ50%, development of a new stenosis Ն30% in a previously normal segment, or progression of any stenosis to total occlusion. CAD progression occurred in 35 patients (28%). After adjustment with binary logistic regression, neopterin (PϽ0.001), high-sensitivity C-reactive protein (Pϭ0.017), matrix metalloproteinase-9 (Pϭ0.002), soluble intercellular adhesion molecule 1 (PϽ0.001), and previous history of unstable angina (Pϭ0.01) were independent predictors of rapid CAD progression. The association between rapid disease progression and inflammatory markers remained significant even when presence of complex lesions was introduced into the multivariate model. Conclusions-Rapid CAD progression in patients with stable angina pectoris is associated with increased C-reactive protein levels and raised concentrations of biochemical markers of endothelial and macrophage activation. (Circulation.

Neopterin and Atherosclerotic Plaque Instability in Coronary and Carotid Arteries

“…Circulating levels of neopterin have been reported to be higher in patients with acute coronary syndrome (ACS) than in control subjects and in patients with stable angina pectoris (SAP) 6,7) . Furthermore, recent studies have shown a direct association between neopterin and plaque instability in coronary arteries [8][9][10][11] ( Table 1). Several coronary angiographic studies have shown a relationship between increased neopterin levels and complex coronary lesions in patients with unstable angina pectoris (UAP) 8,9) ; however, neopterin levels did not correlate with the number of diseased coronary vessels, suggesting that neopterin may be a marker of inflammatory CAD activity rather than a measure of the anatomical extent of the coronary atheromatous process 8,9) .…”

“…Previous clinical studies have demonstrated that neopterin is associated with atherosclerotic plaque instability in coronary artery disease (CAD) [6][7][8][9][10][11][12][13][14][15][16][17] . Circulating levels of neopterin have been reported to be higher in patients with acute coronary syndrome (ACS) than in control subjects and in patients with stable angina pectoris (SAP) 6,7) .…”

“…These findings suggest that neopterin is an important biomarker of plaque instability in both coronary and carotid atherosclerotic lesions. [6][7][8][9][10][11][12][13][14][15][16][17][18] . In this review, we focus on the relationship between neopterin and plaque instability in coronary and carotid arteries, and also introduce the results of our recent studies.…”

The relation between exercise- induced myocardial ischemia and high-sensitive C-reactive protein and neopterin levels

“…Kararlı anjina pektorisli 297 hastanın 1 yıllık takiplerinde neopterinin majör kardiyak olayların bağımsız prediktörü olduğu gösterilmiştir (7). Artmış neopterin düzeyleri ayrıca hipertansif ve tıkayıcı olmayan koroner arter hastalıklı bireylerde istenmeyen kardiyak olay gelişimi ile (35) ve koroner revaskülarizasyon yapılan hastalarda hastalığın hızlı seyri ile ilişkili bulunmuştur (36). Serum neopterin düzeylerinin akut koroner sendromda arttığı ve çatlamış plak varlığını belirlemede, nötrofil sayısı ve CRP'den daha duyarlı olduğu gösteril-miştir (37).…”

Functionally Defective High Density Lipoprotein is Pro-Oxidant: a Deviation from Normal Atheroprotective Character

“…Rapid CHD progression in patients with stable angina pectoris has been shown to be associated with increased C-reactive protein [CRP] levels and raised concentrations of biochemical markers of endothelial and macrophage activation [19]. Cellular adhesion molecules (CAMs) and matrix metalloproteinases (MMPs) have also been suggested to represent an important factor in atheromatous plaque disruption and the occurrence of acute coronary syndromes [20].…”