Elevated serum intercellular adhesion molecule-1 and vascular adhesion molecule-1 among patients with stable angina pectoris who suffer cardiovascular death or non-fatal myocardial infarction

Aims Inflammatory mechanisms have been implicated in the pathogenesis of at herosclerosis. Cell adhesion molecules, expressed on endothelial cells and leukocytes, mediate transendothelial migration of leukocytes into the vesse l wall, but also circulate in soluble forms. In the present study we relate d soluble cell adhesion molecules to the risk of suffering a cardiovascular death or a non-fatal myocardial infarction (cardiovascular death/myocardia l infarction) in a substudy to the Angina Prognosis Study in Stockholm (APS IS). Methods and Results Soluble intercellular adhesion molecule-1, vascular adh esion molecule-1 and E-selectin were measured in serum collected on inclusi on in the APSIS study. During follow-up, seven patients suffered non-fatal myocardial infarction or cardiovascular death, whereas 86 patients were eve nt-free. Cardiovascular death/myocardial infarction was associated with ele vated intercellular adhesion molecule-1 (354 +/- 142 vs 282 +/- 62 ng . ml( -1); P<0.01) and vascular adhesion molecule-1 (538 +/- 138 vs 433 +/- 135 n g . ml(-1); P=0.05), and E-selectin levels tended to be higher (72 +/- 54 v s 49 +/- 20 ng . ml(-1)). Clinical risk factors (history of hypertension, p revious myocardial infarction, diabetes and smoking) were more abundant in the event group. Subgroup analyses showed that hypertension, smoking or mal e sex were associated with elevated intercellular adhesion molecule-1, wher eas previous myocardial infarction or male sex were associated with elevate d vascular adhesion molecule-1. Conclusion Patients with stable angina pectoris who developed cardiovascula r death/myocardial infarction had elevated serum levels of soluble cell adh esion molecules, indicating increased inflammatory activity. The value of s oluble cell adhesion molecules as prognostic markers in patients with stabl e ischaemic heart disease merits further study.