title: Patients with a history of stable or unstable coronary heart disease have different acute phase responses to an inflammatory stimulus.
abstract: Increased levels of acute phase proteins (APP) in serum are associated with vulnerability of atherosclerotic plaques and acute manifestations of coronary heart disease (CHD). APP have been viewed as indexes of active vascular inflammation or as mediators of atherothrombosis. In the present study we tested the hypothesis that individuals who develop stable or unstable forms of CHD might have different innate responses to an inflammatory stimulus. We compared changes in plasma C-reactive protein (CRP) and serum amyloid A (SAA) concentrations 48 h after a standardized inflammatory stimulus (adjuvanted influenza vaccination) in patients with quiescent CHD that had been manifested at onset as inducible myocardial ischemia (Group 1, n=26) or as acute coronary syndromes (ACS) (Group 2, n=34). Selected patients were free from inflammatory or other conditions that might affect the immune response. CRP concentration increased significantly after vaccination in both groups (Group 1: 0.47 [0.21-0.86] to 0.56 [0.32-1.17]mg/L, p=0.005; Group 2: 0.64 [0.21-1.09] to 0.75 [0.33-1.48]mg/L, p=0.003), without significant differences between groups in absolute or percentage changes. By contrast, SAA did not change after vaccination in Group 1 (14.4 [8.9-19.5] to 14.8 [10.3-18.8]mg/L, p=0.88) but increased significantly in Group 2 (16.9 [10.0-21.5] to 19.2 [11.3-29.1]mg/L, p=0.002), with significant differences between the groups in absolute and percentage terms (p=0.015 and 0.019, respectively). Changes in CRP and SAA, both absolute and percentage, were significantly correlated in Group 2 (r=0.60 and 0.66, both p<0.001). The responsiveness of plasma SAA to an inflammatory stimulus in Group 2 alone suggests a pro-inflammatory status in patients prone to acute coronary syndrome but not in those with inducible myocardial ischemia.
authors.affiliation: Centro Cardiologico Monzino IRCCS, Milan, Italy. pablo.werba@ccfm.it
authors.forename: José Pablo
authors.initials: JP
authors.lastname: Werba
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Veglia
authors.forename: Mauro
authors.initials: M
authors.lastname: Amato
authors.forename: Damiano
authors.initials: D
authors.lastname: Baldassarre
authors.forename: Paola
authors.initials: P
authors.lastname: Massironi
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Meroni
authors.forename: Piersandro
authors.initials: P
authors.lastname: Riboldi
authors.forename: Elena
authors.initials: E
authors.lastname: Tremoli
authors.forename: Marina
authors.initials: M
authors.lastname: Camera
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D003327:Coronary Disease / Q000503:physiopathology*; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D007252:Influenza Vaccines / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D000685:Serum Amyloid A Protein / Q000032:analysis*; D014611:Vaccination
chemical_list: D007252:Influenza Vaccines; D000685:Serum Amyloid A Protein; D002097:C-Reactive Protein