Inflammation, atherosclerotic burden and cardiovascular prognosis.
BACKGROUND
The aim of this study was to evaluate the impact of various inflammatory markers on atherosclerotic burden and cardiovascular prognosis.


METHODS
In a prospective study 720 patients preceding coronary angiography were enrolled. In all patients carotid and leg arteries were examined using sonographic methods and C-reactive protein, fibrinogen, interleukin-18 (IL-18) and interleukin-6 have been determined. Patients were compared with regard to atherosclerotic burden: no clinically significant stenosis (N=57, 7.9%), coronary artery disease only (N=362, 50.3%), coronary artery disease with peripheral atherosclerosis (=multi-vascular atherosclerosis, N=301, 41.8%).


RESULTS
Follow-up data after a median of 6.5 years were available in 719 patients (99.9%), 75 patients (10.4%) died from cardiovascular causes. Presence of multi-vascular atherosclerosis, elevation of IL-18 and elevation of fibrinogen were independently related to cardiovascular death in a fully adjusted model Hazard ratio (95% confidence interval) 2.0 (1.2-3.5) for presence of multi-vascular atherosclerosis (P<0.01), 2.2 (1.2-3.9) for high fibrinogen (P<0.01) and 2.8 (1.6-4.9) for high IL-18 (P<0.0001)). Fibrinogen was achieved as independent predictor for both, mortality and atherosclerotic burden, whereas IL-18 was not related to atherosclerotic burden.


CONCLUSIONS
IL-18 was an independent predictor for future cardiovascular death but was not associated with extent of atherosclerosis, whereas fibrinogen was independently related to cardiovascular death and extent of disease.
Espinola-Klein
Christine
C
Medical Department II, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131 Mainz, Germany. espinola@uni-mainz.de
Rupprecht
Hans J
HJ
Bickel
Christoph
C
Lackner
Karl
K
Schnabel
Renate
R
Munzel
Thomas
T
Blankenberg
Stefan
S
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002340:Carotid Artery Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000401:mortality / Q000473:pathology*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D005340:Fibrinogen / Q000032:analysis*; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007249:Inflammation; D020382:Interleukin-18 / Q000097:blood*; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D014463:Ultrasonography
D015415:Biomarkers; D020382:Interleukin-18; D005340:Fibrinogen