Role of novel markers of inflammation in patients with stable coronary heart disease

doi:10.1016/S0002-9149(00)01355-2

The American Journal of Cardiology

Volume 87, Issue 3, 1 February 2001, Pages 262-266

https://doi.org/10.1016/S0002-9149(00)01355-2 Get rights and content

Abstract

The role of novel markers of inflammation in patients with coronary heart disease (CHD) is still unclear. We conducted a case-control study to assess the association between various markers of inflammation and the presence and severity of chronic stable CHD. We included 312 clinically stable patients with angiographically documented CHD, aged 40 to 68 years. Voluntary blood donors (n = 479) matched for age and gender served as controls. High-sensitivity C-reactive protein, serum amyloid A, plasminogen activator inhibitor-1 activity, von Willebrand factor, fibrinogen, plasma viscosity, albumin, and neutrophils were determined. The severity of CHD was evaluated by 3 coronary scoring systems: the clinical 1- to 3-vessel disease score, the American Heart Association extension score (1 to 15 segments), and the Gensini score. All markers of inflammation were highly significantly elevated (all p <0.005) in patients with stable CHD compared with controls. After multivariable adjustment by means of logistic regression analysis, the association between CHD and fibrinogen, plasma viscosity, von Willebrand factor, and plasminogen activator inhibitor-1 activity remained substantial, whereas it decreased in high-sensitivity C-reactive protein, serum amyloid A, and neutrophils. The combination of ≥2 markers of inflammation was associated with a strongly increased risk of CHD. No association between markers of inflammation and any of the coronary scores applied was found. These results document an independent association between most of the markers of inflammation and chronic CHD, even in clinically stable patients. The combination of several of these biochemical markers, i.e., the determination of an “inflammatory risk profile,” may be useful to further stratify cardiovascular risk.

Section snippets

Study design and study participants

The present case-control study was undertaken in a university hospital setting in Southern Germany. Cases included patients aged 40 to 68 years who underwent coronary angiography at the University Hospital of Ulm between October 1996 and November 1997, and who had ≥1 coronary stenosis diameter of ≥50%. Patients with acute coronary syndromes during the last 4 weeks were excluded. Voluntary blood donors from the associated Red Cross blood bank who were frequency matched for age and gender served

Study population

In this study, 791 subjects (312 cases and 479 controls) were enrolled. Response rate among cases was 78% and among controls, 84%. Table 1lists demographic characteristics of the study population. Cardiovascular risk factors were more frequent in cases, whereas daily alcohol consumption and marital status differed little between groups. Mean body mass index and the proportion of subjects with low school education were somewhat higher in cases than in controls. Myocardial infarction had occurred

Discussion

In this study, in patients with chronic stable CHD, highly significantly elevated levels of markers of inflammation were found compared with controls. After multivariable adjustment, the association between CHD and most of these biochemical markers remained substantial, whereas it decreased and became nonsignificant in hs-CRP, SAA, and neutrophils. The combination of several markers of inflammation (inflammatory risk profile) such as hs-CRP with fibrinogen (also a marker of blood coagulation)

Acknowledgements

We are indebted to the staff of the blood bank for their help, and to Gerlinde Trischler and Susan Kuhn for excellent technical assistance. We would also like to thank Professor Mark B. Pepys (FRS), Royal Free and University College Medical School, London, United Kingdom, for providing the monoclonal and polyclonal CRP antibodies, and for his help in establishing the CRP immunoradiometric assay in our laboratory.

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^☆: This study was supported by grants from the Medical Faculty of the University of Ulm, Ulm; and from Astra Chemicals, Wedel, Germany.

View full text

Role of novel markers of inflammation in patients with stable coronary heart disease☆

Abstract

Section snippets

Study design and study participants

Study population

Discussion

Acknowledgements

Am J Cardiol

Lancet

Lancet

Am J Cardiol

Am Heart J

Atherosclerosis—an inflammatory disease

N Engl J Med

Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease—meta-analyses of prospective studies

JAMA

Fibrinogen and cardiovascular risk

Vasc Med

Serum C-reactive protein concentration in acute myocardial infarction and its relationship to mortality during 24 months of follow-up in patients under thrombolytic treatment

Eur Heart J

The prognostic value of C-reactive protein and serum amyloid A protein in severe unstable angina

N Engl J Med

Prognostic influence of increased fibrinogen and C-reactive protein levels in unstable coronary artery disease

Circulation

Peridontitis. A risk factor for coronary heart disease?

Ann Peridont

Symptoms of chronic bronchitis and the risk of coronary disease

Lancet