Document Detail

Inflammatory and non-invasive vascular markers: the multimarker approach for risk stratification in coronary artery disease.
MedLine Citation:
PMID:  18378239     Owner:  NLM     Status:  MEDLINE    
Current thinking supports the notion that several inflammatory proteins intervene with endothelium and haemostatic factors leading to plaque formation and rupture. Of these, C-reactive protein (CRP), monocyte/macrophage colony-stimulating factor (MCSF) and interleukin-6 (IL-6) promote atherogenesis by inducing monocyte-macrophage activation, foam cell formation, platelet activation, tissue factor expression, release of other procoagulant cytokines or downregulation of atheroprotective cytokines such as interleukin 10 and transforming growth factor b-1 (TGFb-1). CRP, MSCF and IL-6 are interrelated and have been found in increased blood concentrations in CAD. Increased levels of CRP and IL-6 predict a higher cardiovascular event rate in the general population and in addition to high MCSF or low TGFb-1 predict adverse outcome in CAD patients independently of traditional risk factors. Moreover, in CAD patients, the predictive value of MCSF is additive and beyond that of CRP suggesting the need of a "multimarker approach" in assessing cardiovascular risk. Accumulating evidence supports the utility of non-invasive markers of subclinical atherosclerosis, namely carotid intimal media thickness, flow mediated dilatation of the brachial artery, augmentation index or pulse wave velocity, in the prediction of cardiovascular risk particularly in primary prevention settings. The combination of these non-invasive tests has been shown to improve their prognostic accuracy compared to each other alone. Although several therapeutic strategies like vaccination against antigens promoting atherogenesis, cyclooxygenase inhibitors, statins, and ACE inhibitors may reduce the levels of these inflammatory markers and improve the non-invasive markers of subclinical atherosclerosis, the impact on cardiovascular risk resulting from these changes is unknown. The combination of an established inflammatory marker such as CRP or a vascular marker such as IMT with novel biochemical and vascular markers of cardiovascular disease may offer additive prognostic information for adverse outcome.
Ignatios Ikonomidis; Kimon Stamatelopoulos; John Lekakis; Georgia D Vamvakou; Dimitrios Th Kremastinos
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Publication Detail:
Type:  Journal Article; Review     Date:  2008-02-29
Journal Detail:
Title:  Atherosclerosis     Volume:  199     ISSN:  1879-1484     ISO Abbreviation:  Atherosclerosis     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-24     Completed Date:  2008-08-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0242543     Medline TA:  Atherosclerosis     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  3-11     Citation Subset:  IM    
2nd Cardiology Department, University of Athens, Attikon Hospital, Perikleous 19, N. Chalkidona, Athens 14343, Greece.
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MeSH Terms
Biological Markers / blood*
Coronary Artery Disease / epidemiology*,  immunology*,  metabolism
Risk Factors
Vasculitis / epidemiology*,  immunology*,  metabolism
Reg. No./Substance:
0/Biological Markers

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