Inflammatory markers in patients with coronary artery disease with and without inflammatory rheumatic disease.
OBJECTIVE
Patients with inflammatory rheumatic diseases (IRDs) have a higher morbidity and mortality from accelerated atherosclerosis than the general population. We hypothesized that patients with the combination of IRD and coronary artery disease (CAD) would have a certain inflammatory phenotype compared with CAD patients without this comorbidity.


METHODS
Four groups of patients were included: patients with IRD, referred to coronary artery bypass grafting (CABG) (CAD-IRD, n = 67), patients without IRD, referred to CABG (CAD, n = 52), patients with IRD without CAD (IRD, n = 32) and healthy controls (n = 30). Plasma levels of several inflammatory markers were analysed by enzyme immunoassays.


RESULTS
(i) Plasma levels of markers of endothelial cell activation [i.e. vascular cell adhesion molecule-1 (VCAM-1) and von Willebrand factor] and osteoprotegerin (OPG) were significantly increased and plasma levels of CCL21 significantly decreased in CAD-IRD patients as compared with CAD patients without IRD. (ii) Within the CAD-IRD group, acute coronary syndrome was a significant predictor of OPG, suggesting an enhanced inflammatory response during plaque destabilization in CAD-IRD patients. (iii) Plasma levels of VCAM-1, OPG and CCL21, but not lipid parameters, IRD characteristics and several other inflammatory markers (e.g. CRP), were significant predictors of CAD-IRD as opposed to CAD in two logistic regression models.


CONCLUSIONS
Our findings further support a role for inflammation in the accelerated form of atherosclerosis in IRD patients, and suggest that certain inflammatory pathways, such as the enhanced endothelial cell activation and the RANK ligand/RANK/OPG system, may be of particular importance.
Breland
Unni M
UM
Research Institute of Internal Medicine, Rikshospitalet University Hospital, Oslo, Norway.
Hollan
Ivana
I
Saatvedt
Kjell
K
Almdahl
Sven M
SM
Damås
Jan K
JK
Yndestad
Arne
A
Mikkelsen
Knut
K
Førre
Oystein T
OT
Aukrust
Pål
P
Ueland
Thor
T
D000368:Aged; D015415:Biomarkers / Q000378:metabolism*; D016022:Case-Control Studies; D018925:Chemokines / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000150:complications* / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D053244:Osteoprotegerin / Q000378:metabolism*; D012044:Regression Analysis; D012216:Rheumatic Diseases / Q000150:complications* / Q000378:metabolism; D012307:Risk Factors
D015415:Biomarkers; D018925:Chemokines; D053244:Osteoprotegerin