title: The association of serum neutrophil markers and acute coronary syndrome.
abstract: An association exists between chronic infection-induced inflammation, such as periodontitis, and acute coronary syndrome (ACS). We studied the association of serum neutrophil markers, myeloperoxidase (MPO), matrix metalloproteinase (MMP)-8, tissue inhibitor of metalloproteinase (TIMP)-1 concentrations and MMP-8/TIMP-1 ratio, with the risk of recurrent ACS. Radiographic periodontal status was recorded from 141 patients with acute non-Q-wave infarction or unstable angina pectoris, who participated in a double-blind, placebo-controlled study with clarithromycin for 3 months. Serum samples were collected within arrival to the hospital, at 1 week, 3 months and 1 year. Recurrent ACS events were registered during the 1-year follow-up. In the whole population, high serum MPO concentrations at 1 week (fourth quartile versus quartiles 1-3) were associated with the risk of recurrent ACS with a relative risk (RR) of 2.52 (95% CI, 1.277-4.980; P = 0.008). In patients without periodontal disease, high MPO concentration at 1 week and 1 year predicted recurrent ACS with RRs of 3.54 (1.600-7.831; P = 0.002) and 2.87 (1.171-7.038; P = 0.021), respectively. In the placebo group, but not in the clarithromycin group, high serum MMP-8/TIMP-1 ratio at 1 week predicted recurrent ACS with an RR of 3.23 (1.295-8.063; P = 0.012). Our results suggest that high serum neutrophil markers reflect increased risk of recurrent ACS, especially in patients without periodontal disease and not receiving antimicrobial medication.
authors.affiliation: Institute of Dentistry, University of Helsinki, and Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland. hatem.alfakry@helsinki.fi
authors.forename: Hatem
authors.initials: H
authors.lastname: Alfakry
authors.forename: Juha
authors.initials: J
authors.lastname: Sinisalo
authors.forename: Susanna
authors.initials: S
authors.lastname: Paju
authors.forename: Markku S
authors.initials: MS
authors.lastname: Nieminen
authors.forename: Ville
authors.initials: V
authors.lastname: Valtonen
authors.forename: Taina
authors.initials: T
authors.lastname: Tervahartiala
authors.forename: Pirkko J
authors.initials: PJ
authors.lastname: Pussinen
authors.forename: Timo
authors.initials: T
authors.lastname: Sorsa
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis; D000368:Aged; D015415:Biomarkers / Q000097:blood; D006801:Humans; D020784:Matrix Metalloproteinase 8 / Q000097:blood*; D008875:Middle Aged; D009504:Neutrophils / Q000737:chemistry*; D009195:Peroxidase / Q000097:blood*; D012008:Recurrence; D012307:Risk Factors; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000097:blood*
chemical_list: D015415:Biomarkers; C560822:TIMP1 protein, human; D019715:Tissue Inhibitor of Metalloproteinase-1; D009195:Peroxidase; D020784:Matrix Metalloproteinase 8