[The role of inflammation in the pathophysiology of acute coronary syndromes].
All stages of atherosclerotic plaques are characterized by an inflammatory component, in which T lymphocytes and macrophages orchestrate lesion progression and destabilization by releasing cytokines (e.g., interferon-gamma, tumor necrosis factor-alpha, tissue factor). At the extreme end of this process plaque rupture occurs, which may manifest clinically as an acute coronary syndrome. Hence, measuring this atherosclerosis-inherent inflammation may help predicting cardiovascular events. Accordingly, different soluble inflammatory markers were studied for their predictive value in acute coronary syndromes. Special attention was paid to high-sensitivity C-reactive protein (hs-CRP) and soluble CD40 ligand (sCD40L). The latter seems not only to be a marker of inflammation and platelet activation, but is suggested to directly destabilize atherosclerotic plaques by stimulating pro-inflammatory T lymphocytes. Therefore, reduction of soluble inflammatory markers is an attractive target for future therapeutic strategies. Statins and glycoprotein IIb/IIIa antagonists, well-established treatments in acute coronary syndromes, were demonstrated to decrease hs-CRP and sCD40L. Whether this reduction translates into a better prognosis has to be investigated in further studies.
Alber
Hannes F
HF
Klinische Abteilung für Kardiologie, Medizinische Universität Innsbruck, Innsbruck, Austria.
Suessenbacher
Alois
A
Weidinger
Franz
F
D000208:Acute Disease; D000789:Angina, Unstable / Q000188:drug therapy / Q000276:immunology*; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000276:immunology*; D019013:CD40 Antigens / Q000276:immunology*; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000276:immunology*; D016207:Cytokines / Q000276:immunology; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy / Q000276:immunology*; D013577:Syndrome; D014657:Vasculitis / Q000188:drug therapy / Q000276:immunology*
D000893:Anti-Inflammatory Agents; D019013:CD40 Antigens; D016207:Cytokines; D002097:C-Reactive Protein