Prognostic significance of high levels of lipoprotein (a) and C-reactive protein in coronary artery disease
DOI:
https://doi.org/10.18203/2320-6012.ijrms20251289Keywords:
Coronary artery disease, Lipoprotein (a), CRP, Inflammatory process, Mortality rateAbstract
Background: Inflammatory markers have been associated with clinical outcome in patients with coronary artery disease (CAD). Atherosclerotic cardiovascular disease is the leading cause of mortality, accounting for more than 15 million deaths worldwide every year. The present study was done to evaluate the role of serum C-reactive protein (CRP) and serum lipoprotein (S. Lp) (a) in CAD.
Methods: Sixty patients admitted in Guru Nanak Dev Hospital, Amritsar and sixty healthy subjects were included, and they were followed up for 180 days for any major cardiovascular events after the treatment. Clinical parameters like S. Lp (a) and S. CRP levels were evaluated as risk factors for coronary artery disease and as predictors of major cardiovascular events (such as the occurrence of cardiac death, ischemic stroke or myocardial infarction and mortality.
Results: Patients were further categorized into three groups based on serum Lp (a) and serum CRP levels: group A: S. Lp (a) levels >30 mg/dl and S. CRP >5 mg/l, group B: S. Lp (a) levels >30 mg/dl and S. CRP levels were normal, group C: S. Lp (a) levels <30 mg/dl and S. CRP >3 mg/l. Patients with S. Lp (a) >30 mg/dl and S. CRP levels >5 mg/l had a significantly lower survival than the other two groups. When compared with normal healthy subjects S. Lp (a) and S. CRP levels were statistically higher in patients of ACS.
Conclusion: The adverse effects of elevated S. Lp (a) levels and S. CRP levels on cardiovascular system have been associated with endothelial dysfunction, inflammatory cells migration and infiltration, oxidative stress, and fibrinolysis inhibition. These inflammatory processes together lead to cardiovascular events and high levels of these inflammatory markers leads to high mortality rates.
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References
Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, et al. 2021 AHA/ACC/ASE/ CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2021;144(22):e368-454.
Ahmed OE, Abohamr SI, Alharbi SA, Aldrewesh DA, Allihimy AS, Alkuraydis SA, et al. In-hospital mortality of acute coronary syndrome in elderly patients. Saudi Med J. 2019;40(10):1003-7. DOI: https://doi.org/10.15537/smj.2019.10.24583
Chapman AR, Hesse K, Andrews J, Lee KK, Anand A, Shah ASV, et al. High-Sensitivity Cardiac Troponin I and Clinical Risk Scores in Patients With Suspected Acute Coronary Syndrome. Circulation. 2018;138(16):1654-65. DOI: https://doi.org/10.1161/CIRCULATIONAHA.118.036426
Gawinski L, Engelseth P, Kozlowski R. Application of modern clinical risk scores in the global assessment of risks related to the diagnosis and treatment of acute coronary syndromes in everyday medical practice. Int J Environ Res Public Health. 2021;18:9103. DOI: https://doi.org/10.3390/ijerph18179103
Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2021;144(22):e368-454. DOI: https://doi.org/10.1161/CIR.0000000000001030
Arora S, Stouffer GA, Kucharska-Newton AM, Qamar A, Vaduganathan M, Pandey A, et al. Twenty year trends and sex differences in young adults hospitalized with acute myocardial infarction. Circulation. 2019;139(8):1047-56. DOI: https://doi.org/10.1161/CIRCULATIONAHA.118.037137
Mestas J, Ley K. Monocyte-endothelial cell interactions in the development of atherosclerosis. Trends Cardiovasc Med. 2008;18:228-32. DOI: https://doi.org/10.1016/j.tcm.2008.11.004
Rader DJ, Daugherty A. Translating molecular discoveries into new therapies for atherosclerosis. Nature. 2008;451:904-13. DOI: https://doi.org/10.1038/nature06796
Libby P, Okamoto Y, Rocha VZ, Folco E. Inflammation in atherosclerosis: transition from theory to practice. Circ J. 2010;74:213-20. DOI: https://doi.org/10.1253/circj.CJ-09-0706
Willerson JT, Ridker PM. Inflammation as a cardiovascular risk factor. Circulation. 2004;109:II2-10. DOI: https://doi.org/10.1161/01.CIR.0000129535.04194.38
Paffen E, DeMaat MP. C-reactive protein in atherosclerosis: a causal factor? Cardiovasc Res. 2006;71:30-9. DOI: https://doi.org/10.1016/j.cardiores.2006.03.004
Ross R. Atherosclerosis – an inflammatory disease. N Engl J Med. 1999;340:115-26. DOI: https://doi.org/10.1056/NEJM199901143400207
Pfutzner A, Schondorf T, Hanefeld M, Forst T. High-sensitivity C-reactive protein predicts cardiovascular risk in diabetic and nondiabetic patients: effects of insulin-sensitizing treatment with pioglitazone. J Diabetes Sci Technol. 2010;4:706-16. DOI: https://doi.org/10.1177/193229681000400326
Davis FJ, Vidyasagar S, Maiya GA. C-reactive protein and coronary heart disease - risk marker or risk factor? J Clin Sci Res. 2012;1:178-86. DOI: https://doi.org/10.4103/2277-5706.241515
Biasucci L, Liuzzo G, Grillo R, Caligiuri G, Rebuzzi A, Buffon A, et al. Elevated levels of C-reactive protein at discharge in patients with unstable angina predict recurrent instability. Circulation. 1999;99:855-60. DOI: https://doi.org/10.1161/01.CIR.99.7.855
Mueller C, Buettner H, Hodgson J, Marsch S, Perruchoud A, Roskamm H, et al. Inflammation and long-term mortality after non-ST elevation acute coronary syndrome treated with a very early invasive strategy in 1042 consecutive patients. Circulation. 2002;105:1412-5. DOI: https://doi.org/10.1161/01.CIR.0000012625.02748.62
Gencer B, Kronenberg F, Stroes ES, Mach F. Lipoprotein(a): the revenant. Eur Heart J. 2017;38:1553-60. DOI: https://doi.org/10.1093/eurheartj/ehx033
Schnitzler JG, Hoogeveen RM, Ali L, Prange KHM, Waissi F, van Weeghel M, et al. Atherogenic Lipoprotein(a) Increases Vascular Glycolysis, Thereby Facilitating Inflammation and Leukocyte Extravasation. Circ Res. 2020;126(10):1346-59. DOI: https://doi.org/10.1161/CIRCRESAHA.119.316206
Sotiriou SN, Orlova VV, Al-Fakhri N, Ihanus E, Economopoulou M, Isermann B, et al. Lipoprotein(a) in atherosclerotic plaques recruits inflammatory cells through interaction with Mac-1 integrin. FASEB J. 2006;20(3):559-61S. DOI: https://doi.org/10.1096/fj.05-4857fje
Hajjar KA, Gavish D, Breslow JL, Nachman RL. Lipoprotein(a) modulation of endothelial cell surface fibrinolysis and its potential role in atherosclerosis. Nature. 1989;339(6222):303-5. DOI: https://doi.org/10.1038/339303a0
Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41:111-88. DOI: https://doi.org/10.15829/1560-4071-2020-3826
Baltz ML, De Beer FC, Feinstein A, Munn EA, Milstein CP, Fletcher TC, et al. Phylogenetic aspects of C-reactive protein and related proteins. Ann NY Acad Sci. 1982;389:459. DOI: https://doi.org/10.1111/j.1749-6632.1982.tb22125.x
Poulik MD, Weiss ML. In: Putman FW, Editor. The Plasma Proteins. Volume 2. Second Edition. Academic Press, New York. 1975;52-108.
Stein EA, Myers GL. Lipids, Lipoproteins and Apolipoproteins in Tietz Textbook of Clinical Chemistry. In: Burtis CA, Ashwood ER, editors. Tietz Textbook of Clinical Chemistry. 2nd edition. Philadelphia, USA: WB Saunders Company. 1994;1002-93.
Burstein M, Scholnick HR, Morfin R. Rapid method for the isolation of lipoproteins from human serum by precipitation with polyanions. J Lipid Res. 1970;11(6):583-95. DOI: https://doi.org/10.1016/S0022-2275(20)42943-8
Ragland BD, Konrad RJ, Chaffin C, Robinson CA, Hardy RW. Evaluation of a homogenous direct LDL-Cholesterol assay in diabetic patients: effect of glycemic control. Clin Chem. 2000:46(11):1848-51. DOI: https://doi.org/10.1093/clinchem/46.11.1848
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499-502. DOI: https://doi.org/10.1093/clinchem/18.6.499
Guder WG. The quality of diagnostic samples. 1st Edition. Darmstaddt: GIT Verlag. 2001;30-1.
Xu J, Murphy SL, Kockanek KD, Arias E. Mortality in the United States, 2018. NCHS Data Brief. 2020;355:1-8.
Bostom AG, Gagnon DR, Cupples LA, Wilson PW, Jenner JL, Ordovas JM, et al. A prospective investigation of elevated lipoprotein (a) detected by electrophoresis and cardiovascular disease in women. The Framingham Heart Study. Circulation. 1994;90(4):1688-95. DOI: https://doi.org/10.1161/01.CIR.90.4.1688
Virani SS, Brautbar A, Davis BC, Nambi V, Hoogeveen RC, Sharrett AR, et al. Associations between lipoprotein(a) levels and cardiovascular outcomes in black and white subjects:the Atherosclerosis Risk in Communities (ARIC) Study. Circulation. 2012;125(2):241-9. DOI: https://doi.org/10.1161/CIRCULATIONAHA.111.045120
Kwon SW, Lee BK, Hong BK, Kim JY, Choi EY, Sung JM, et al. Prognostic significance of elevated lipoprotein(a) in coronary artery revascularization patients. Int J Cardiol. 2013;167(5):1990-4. DOI: https://doi.org/10.1016/j.ijcard.2012.05.007
Enas EA, Yusuf S, Mehta JL. Prevalence of coronary artery disease in Asian Indians. Am J Cardiol. 1992;70(9):945-9. DOI: https://doi.org/10.1016/0002-9149(92)90744-J
Mach F, Lovis C, Gaspoz JM, Unger PF, Bouillie M, Urban P, et al. C-reactive protein as a marker for acute coronary syndromes. Eur Heart J. 1997;18:1897-902. DOI: https://doi.org/10.1093/oxfordjournals.eurheartj.a015198
Karki P, Agrawaal KK, Lamsal M, Shrestha NR. Predicting outcomes in acute coronary syndrome using biochemical markers. Indian Heart J. 2015;67:529-37. DOI: https://doi.org/10.1016/j.ihj.2015.06.029
Puri R, Nissen SE, Arsenault BJ, St John J, Riesmeyer JS, Ruotolo G, et al. Effect of C-Reactive Protein on Lipoprotein(a)-Associated Cardiovascular Risk in Optimally Treated Patients With High-Risk Vascular Disease: A Prespecified Secondary Analysis of the ACCELERATE Trial. JAMA Cardiol. 2020;5(10):1136-43. DOI: https://doi.org/10.1001/jamacardio.2020.2413