title: Further evaluation of plasma sphingomyelin levels as a risk factor for coronary artery disease.
abstract: BACKGROUND
  Sphingomyelin (SM) is the major phospholipid in cell membranes and in lipoproteins. In human plasma, SM is mainly found in atherogenic lipoproteins; thus, high levels of SM may promote atherogenesis.
  
  
  METHODS
  We investigated in a median follow up of 6.0 years the association of SM with the incidence of a combined endpoint (myocardial infarction and cardiovascular death) in stable and unstable patients, and its relation to other marker of atherosclerosis in 1,102 patients with angiographically documented CAD and 444 healthy controls.
  
  
  CONCLUSIONS
  Logistic regression analysis showed that SM categorized by median was associated with an elevated risk for CAD (HR 3.2, 95%CI 2.5-4.0, p < 0.05). SM levels were correlated with apoB (r = 0.34) and triglyceride levels (r = 0.31). In patients with stable angina (n = 614), SM categorized by median was not related to incidence of a combined endpoint (cardiovascular death and myocardial infarction) (p = 0.844 by Log-rank test). However, in patients with acute coronary syndrome (n = 488), elevated SM was related to the combined endpoint (p < 0.05 by Log-rank test), also in a multivariate Cox regression analysis including potential confounders (HR 1.8, 95%CI 1.0-3.3, p < 0.05).
  
  
  CONCLUSIONS
  The results of our study reveal that 1) human plasma SM levels are a risk factor for CAD; 2) the pro-atherogenic property of plasma SM might be related to metabolism of apoB-containing or triglyceride-rich lipoproteins; and 3) plasma SM levels are a predictor for outcome of patients with acute coronary syndrome.
authors.affiliation: Department of Anatomy and Cell Biology and Scientific Computing Center, State University of New York, Downstate Medical Center, Brooklyn, USA. axel.schlitt@medizin.uni-halle.de
authors.forename: Axel
authors.initials: A
authors.lastname: Schlitt
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.forename: Daoguang
authors.initials: D
authors.lastname: Yan
authors.forename: Hans
authors.initials: H
authors.lastname: von Gizycki
authors.forename: Michael
authors.initials: M
authors.lastname: Buerke
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
authors.forename: Christoph
authors.initials: C
authors.lastname: Bickel
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Lackner
authors.forename: Juergen
authors.initials: J
authors.lastname: Meyer
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Rupprecht
authors.forename: Xian-Cheng
authors.initials: XC
authors.lastname: Jiang