title: Serum neopterin, nitric oxide, inducible nitric oxide synthase and tumor necrosis factor-alpha levels in patients with ischemic heart disease.
abstract: BACKGROUND
  Atherosclerosis, a chronic inflammatory disease, underlies the pathogenesis of coronary artery disease. The present study assessed the diagnostic possibilities of inflammatory biomarkers, serum neopterin, nitrite/nitrate (NO2(-)/NO3(-)), inducible nitric oxide synthase (iNOS) and tumor necrosis factor-alpha (TNF-alpha), and their correlation with risk factors in patients with acute coronary syndromes and stable angina pectoris.
  
  
  METHODS
  We studied 44 patients with chronic stable angina pectoris, 46 with unstable angina, 55 with acute ST-elevation myocardial infarction and 39 age-matched healthy volunteers (control group). Serum neopterin, iNOS and TNF-alpha were determined with commercially available enzyme linked immunosorbent assay methods and NO2(-)/NO3(-) by the modified cadmium-reduction method.
  
  
  RESULTS
  Mean serum neopterin levels were significantly higher in patients with unstable and stable angina pectoris in comparison to control subjects (p<0.01 and p<0.05, respectively). Serum NO2(-)/NO3(-) values were significantly elevated (p<0.01) only in patients with unstable angina. ST-elevation myocardial infarction patients with cardiac death during follow-up showed significantly lower baseline neopterin values (p<0.001), and higher NO2(-)/NO3(-) levels (p<0.05) in comparison to those without adverse events. Significantly higher NO2(-)/NO3(-) values (p<0.05) were also found in patients who had myocardial reinfarction. Serum iNOS and TNF-alpha in all patient groups were within control ranges. A strong correlation was found between neopterin and both smoking (p<0.01) and triglycerides (p<0.05) in unstable angina patients. In stable angina patients, neopterin, iNOS and TNF-alpha significantly correlated with hypertension (p<0.01) and triglycerides (p<0.05). A significant difference in neopterin concentration was found between smokers and non-smokers (p<0.05).
  
  
  CONCLUSIONS
  The results of this study suggest that in stable angina patients, if studied over time, serum neopterin or NO2(-)/NO3(-) levels may indicate future plaque instability. In ST-elevation myocardial infarction patients, neopterin and/or NO2(-)/NO3(-) levels may identify patients at long-term risk of death or recurrent acute coronary events after myocardial infarction.
authors.affiliation: Center for Medical Biochemistry, Clinical Center, Nis, Serbia. czmb_kc_nis@yahoo.com
authors.forename: Vidosava B
authors.initials: VB
authors.lastname: Djordjevic
authors.forename: Ivana
authors.initials: I
authors.lastname: Stojanovic
authors.forename: Vladan
authors.initials: V
authors.lastname: Cosic
authors.forename: Lilika
authors.initials: L
authors.lastname: Zvezdanovic
authors.forename: Marina
authors.initials: M
authors.lastname: Deljanin-Ilic
authors.forename: Senada
authors.initials: S
authors.lastname: Dimic
authors.forename: Braca
authors.initials: B
authors.lastname: Kundalic
authors.forename: Tatjana
authors.initials: T
authors.lastname: Cvetkovic
authors.forename: Tatjana
authors.initials: T
authors.lastname: Jevtovic-Stoimenov
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood*; D019798:Neopterin / Q000097:blood*; D009569:Nitric Oxide / Q000097:blood*; D052247:Nitric Oxide Synthase Type II / Q000097:blood*; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha; D009569:Nitric Oxide; D019798:Neopterin; D052247:Nitric Oxide Synthase Type II