title: Low levels of IgG autoantibodies against the apolipoprotein B antigen p210 increases the risk of cardiovascular death after carotid endarterectomy.
abstract: OBJECTIVE
  Autoimmune responses against oxidized-LDL (oxLDL) have been suggested to modulate inflammation in atherosclerosis. Previous studies showed an association between autoantibodies against the apolipoprotein B (apoB) p210 antigen and a lower risk of cardiovascular (CV) events. In the present study we investigated if autoantibodies against p210 at the time of carotid endarterectomy (CEA) predict risk for future CV events.
  
  
  METHODS
  Native (nat) and malondialdehyde (MDA)-modified apoB p210 autoantibodies (IgM-p210nat, IgG-p210nat, IgM-p210MDA and IgG-p210MDA) were analyzed by ELISA from plasma samples of 351 patients at the time they underwent CEA. The incidence of postoperative CV events was assessed using national registers.
  
  
  RESULTS
  A total of 52 non-fatal and 15 fatal CV events were registered during the follow-up period (35.1 ± 16.7 months). Patients who suffered from a fatal CV event had significantly lower plasma levels of IgG-p210nat and IgG-p210MDA. Kaplan-Meier curves of event-free survival showed increased CV mortality in patients with levels of IgG-p210nat and IgG-p210MDA below the median (Log Rank 7.813, p .005 and 9.105, p .003 respectively). The association between low levels of p210 IgG and fatal post-operative CV events remained significant when adjusting for age, sex, total cholesterol, HDL cholesterol, smoking habits and hypertension in a Cox Proportional Hazard model (hazard ratios (HR) IgG-p210nat below median: HR 6.7 (95% C.I. 1.5-30.6, p .013) and IgG-p210MDA below median: HR 7.8 (95% C.I. 1.7-35.5, p .008).
  
  
  CONCLUSIONS
  The present findings support the notion that autoantibodies against LDL antigens are involved in the atherosclerotic disease process and suggest that CEA patients with low levels of IgG-p210nat and IgG-p210MDA have an increased risk of post-operative CV death.
authors: Vascular Center Malmö, Skåne University Hospital, Malmö, Sweden. Electronic address: giuseppe.asciutto@med.lu.se.
authors: Giuseppe
authors: G
authors: Asciutto
authors: Vascular Center Malmö, Skåne University Hospital, Malmö, Sweden.
authors: Nuno V
authors: NV
authors: Dias
authors: Experimental Cardiovascular Research Unit, Clinical Research Center, Dept. of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
authors: Andreas
authors: A
authors: Edsfeldt
authors: Experimental Cardiovascular Research Unit, Clinical Research Center, Dept. of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
authors: Ragnar
authors: R
authors: Alm
authors: Experimental Cardiovascular Research Unit, Clinical Research Center, Dept. of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
authors: Gunilla N
authors: GN
authors: Fredrikson
authors: Experimental Cardiovascular Research Unit, Clinical Research Center, Dept. of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
authors: Isabel
authors: I
authors: Gonçalves
authors: Experimental Cardiovascular Research Unit, Clinical Research Center, Dept. of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
authors: Jan
authors: J
authors: Nilsson
mesh_terms: D000368:Aged; D000941:Antigens / Q000737:chemistry; D053299:Apolipoprotein B-100 / Q000097:blood* / Q000276:immunology; D050197:Atherosclerosis / Q000503:physiopathology; D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000276:immunology* / Q000503:physiopathology; D002339:Carotid Arteries / Q000473:pathology; D016893:Carotid Stenosis / Q000503:physiopathology; D003251:Constriction, Pathologic / Q000503:physiopathology; D018572:Disease-Free Survival; D016894:Endarterectomy, Carotid; D004797:Enzyme-Linked Immunosorbent Assay; D000939:Epitopes / Q000737:chemistry; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology*; D053208:Kaplan-Meier Estimate; D008077:Lipoproteins, LDL / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012306:Risk; D016896:Treatment Outcome
chemical_list: C569471:APOB protein, human; D000941:Antigens; D053299:Apolipoprotein B-100; D001323:Autoantibodies; D000939:Epitopes; D007074:Immunoglobulin G; D008077:Lipoproteins, LDL; C099252:oxidized low density lipoprotein
keywords: Apolipoprotein B; Autoantibodies; Cardiovascular events; Carotid stenosis