Coronary artery diseasePregnancy-Associated Plasma Protein-A Elevation in Patients With Acute Coronary Syndrome and Subsequent Atorvastatin Therapy
Section snippets
Methods
Patients were identified for this study at the time they were scheduled for invasive coronary arteriography. Angiography was performed for clinical indications in a study approved by the institutional review board of Abbott Northwestern Hospital (Minneapolis, Minnesota). The patients surveyed included both inpatient and outpatient populations. Patients underwent medication review to determine whether they were using a statin at the time of presentation. Inclusion criteria were 18 years old, no
Results
Ninety-five patients gave consent to participate in the study, 9 of whom were found to have no CAD using coronary angiography. Of the 86 remaining patients, 35 had a diagnosis of ACS and 51 had a diagnosis of stable coronary disease. Figure 1 shows that PAPP-A in the ACS group was more than double that of patients with stable CAD at 2.05 (interquartile range 1.02 to 4.45) versus 0.75 mIU/L (interquartile range 0.42 to 1.47, p <0.001). hs-CRP was higher in the ACS group (Figure 1), but not
Discussion
This study found that PAPP-A increased in patients with ACS compared with patients with stable CAD. This finding was consistent with previous PAPP-A studies that showed increased levels in patients with unstable coronary artery lesions4 and a recent study that showed PAPP-A increased in patients with ST-elevation myocardial infarction.12 Previous studies suggested that infarction of the myocardium by itself did not lead to increased PAPP-A.4 Rather, it was likely that plaque instability in this
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Cited by (26)
Pregnancy-associated plasma protein-A in atherosclerosis: Molecular marker, mechanistic insight, and therapeutic target
2018, AtherosclerosisCitation Excerpt :Statins, also known as 3-hydroxy-3-methylglutaryl CoA reductase inhibitors, have been widely used to reduce the risk of cardiovascular events in both primary and secondary prevention. Treatment with high-dose atorvastatin (80 mg/d) for one month was shown to decrease serum PAPP-A levels in ACS patients, suggesting that blocking PAPP-A might be also involved in the beneficial effects of atorvastatin on cardiovascular system [122]. Conversely, circulating PAPP-A levels are unchangeable in ACS patients receiving low-dose atorvastatin (10 mg/d) or fluvastatin (80 mg/d) therapy [122,123].
PAPP-A in cardiac and non-cardiac conditions
2013, Clinica Chimica ActaCitation Excerpt :Statins have been widely used in cardiovascular diseases for their versatile function such as regulation of lipid level, anti-inflammation and endothelium repair. However, it remains unknown whether stains have established an effect in reducing PAPP-A. Miedema et al. [58] reported that high-dose atorvastatin (80 mg/d) could decrease the serum PAPP-A in ACS patients after one month treatment. However, these results could not be confirmed in ACS patients under the low-dose atorvastatin (10 mg/d or 20 mg/d) or fluvasatin (80 mg/d) [59].
The expression of IGFs and IGF binding proteins in human carotid atherosclerosis, and the possible role of IGF binding protein-1 in the regulation of smooth muscle cell proliferation
2012, AtherosclerosisCitation Excerpt :The different gene association profiles between IGFBP-1 and other five IGFBPs indicated the gene expression of these binding proteins might be regulated differently. Recently, IGFBP-4 activity has been of focus since pregnancy-associated plasma protein-A (PAPP-A), an IGFBP-4 protease, has been shown to be increased in patients with acute coronary syndrome, and double knockout mice lacking ApoE and PAPP-A showed decreased lesion development [22,23]. These studies suggest that the bioavailability of IGF-1 in atherosclerotic lesions, regulated by its affinity for IGFBP-4, may influence plaque progression.
Studies on the effects of heparin products on pregnancy-associated plasma protein A
2011, Clinica Chimica ActaCitation Excerpt :Pregnancy-associated plasma protein A (PAPP-A) has been studied as a novel cardiac risk marker in acute coronary syndromes (ACS). Elevated circulating concentrations have been detected in ACS patients and the concentration has been found to be associated with increased risk of major adverse cardiac events such as a new myocardial infarction or death [1–12]. However, recent findings have shown that intravenous medication with heparin products elicits a rapid elevation in the circulating PAPP-A levels.
Is Serum Pregnancy-Associated Plasma Protein A Really a Potential Marker of Atherosclerotic Carotid Plaque Stability?
2010, European Journal of Vascular and Endovascular SurgeryCitation Excerpt :High uncomplexed amounts of circulating PAPP-A could be a marker of oxidative stress. Stulc and Miedema described that serum PAPP-A levels were significantly higher in patients with severe hypercholesterolemia than in healthy normolipidaemic control subjects, despite the absence of clinically manifest atherosclerosis.20,23 This suggests that an increase in PAPP-A may reflect earlier stages of atherosclerotic lesions, even in the absence of clinical signs of atherosclerosis.
Identification of myocardial injury in the emergency setting
2010, Clinical Biochemistry
This work was supported by grants from the J. Holden DeHaan Foundation, Naples, Florida, and the Pfizer Pharmaceutical Company, New York, New York.