title: Endothelial function after ST-elevation myocardial infarction in patients with high levels of high-sensitivity CRP and Lp-PLA2: A substudy of the RESPONSE randomized trial.
abstract: BACKGROUND
  The combination of high levels of high-sensitive C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase-A2(Lp-PLA2) was recently shown to correlate with increased cardiovascular risk. Endothelial dysfunction is also known to be a risk factor for cardiovascular events.
  
  
  OBJECTIVE
  To test among patients with previous ST-elevation myocardial infarction (STEMI) the hypothesis that high levels of both hs-CRP and Lp-PLA2may be associated with impaired endothelium-dependent vasodilatation.
  
  
  METHODS
  In this substudy of the RESPONSE randomized trial, we used reactive hyperemia peripheral artery tonometry (RH-PAT) 4 to 6weeks after STEMI and primary percutaneous coronary intervention (PPCI) to non-invasively assess endothelial function (RH-PAT index <1.67 identified endothelial dysfunction). Reliable measurements of RH-PAT, hs-CRP, and Lp-PLA2were obtained in 68 patients, who were classified as high-risk if levels of both hs-CRP and Lp-PLA2were in the upper tertile (≥3.84mg/L and >239μg/L, respectively).
  
  
  RESULTS
  Patients were 57.4±9.7years and 53 (77.9%) were men. 11 (16%) patients were classified as high-risk and 57 (84%) as low-to-intermediate-risk. The RH-PAT index was 1.68±0.22 in high-risk and 1.95±0.63 in low-to-intermediate-risk patients (p=0.17). Endothelial dysfunction was present in 8 (72.7%) high-risk and 26 (45.6%) low-to-intermediate-risk patients (p=0.09). Framingham risk score, NT-proBNP and fibrinogen levels were higher in high-risk patients (p≤0.03).
  
  
  CONCLUSIONS
  In this population of patients with recent STEMI and PPCI, we observed between patients with high hs-CRP and Lp-PLA levels and all other patients no more than numerical differences in endothelial function that did not reach a statistical significance. Nevertheless, further research in larger study populations may be warranted.
authors.affiliation: Department of Cardiology, Thoraxcentrum Twente, MST, Enschede, Netherlands.
authors.forename: Jasveen J
authors.initials: JJ
authors.lastname: Kandhai-Ragunath
authors.affiliation: MESA, Institute for Nanotechnology, University of Twente, Enschede, Netherlands.
authors.forename: Bjorn
authors.initials: B
authors.lastname: de Wagenaar
authors.affiliation: Medlon Laboratory Diagnostics, Medisch Spectrum Twente, Enschede, Netherlands.
authors.forename: Cees
authors.initials: C
authors.lastname: Doelman
authors.affiliation: Department of Cardiology, Thoraxcentrum Twente, MST, Enschede, Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: van Es
authors.affiliation: Department of Cardiology, Academisch Medisch Centrum, Amsterdam, Netherlands.
authors.forename: Harald T
authors.initials: HT
authors.lastname: Jørstad
authors.affiliation: Department of Cardiology, Academisch Medisch Centrum, Amsterdam, Netherlands.
authors.forename: Ron J G
authors.initials: RJG
authors.lastname: Peters
authors.affiliation: Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands.
authors.forename: Carine J M
authors.initials: CJM
authors.lastname: Doggen
authors.affiliation: Department of Cardiology, Thoraxcentrum Twente, MST, Enschede, Netherlands; Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands. Electronic address: c.vonbirgelen@mst.nl.
authors.forename: Clemens
authors.initials: C
authors.lastname: von Birgelen
mesh_terms: D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase / Q000097:blood*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D008297:Male; D008365:Manometry; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D014664:Vasodilation
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase; C526684:PLA2G7 protein, human
keywords: Endothelial function (dysfunction); High-sensitive C-reactive protein (hs-CRP); Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)); ST-elevation myocardial infarction (STEMI)