Increased serum neopterin: a marker of coronary artery disease activity inwomen

Objective-To assess whether neopterin concentrations in women with unstable angina differ from those in women with chronic stable angina. Design-Prospective cohort study. Setting-University hospital in south west London. Patients-114 consecutive women with angina were studied: 82 had chronic sta ble angina (typical exertional chest pain, positive exercise ECG testing, a nd/or abnormal myocardial scintigraphy; symptoms stable for at least three months), and 32 had unstable angina (Braunwald class III). All patients wit h chronic stable angina (100%) and 18 with unstable angina (56.3%) underwen t digital coronary angiography; neopterin concentrations were determined us ing a commercially available immunoassay. Main outcome measures-Major clinical events during one year follow up were readmission with Braunwald's class IIIb unstable angina, non-fatal myocardi al infarction, and cardiac death. Results-Major events occurred in 12 women with chronic stable angina (14.6% ) and nine women with unstable angina (28.1%). Mean (range) neopterin conce ntrations were significantly higher in women with unstable angina than in t hose with chronic stable angina (7.6 (5.1-11.5) nmol/l v 5.9 (4.4-7.5) nmol /l; p = 0.003), even after adjustment for variables which were significantl y different on univariate analysis. In women with chronic stable angina, ba seline neopterin concentrations were higher in those with cardiac events th an in those without events (7.1 (5.9-9.1) nmol/l v 5.7 (3.9-7.3 nmol/l); p = 0.010), even after adjustment for variables with significant differences between both groups on univariate analysis. Conclusions-On average, women with unstable angina had significantly higher neopterin concentrations than women with chronic stable angina. Women with chronic stable angina with events during follow up had higher neopterin co ncentrations than those without events. Neopterin concentrations were simil ar in patients with unstable angina and women with chronic stable angina wh o developed events. Neopterin concentrations may therefore be a marker of r isk in women with coronary artery disease.