Role of novel markers of inflammation in patients with stable coronary heart disease

The role of novel markers of inflammation in patients with coronary heart d isease (CHD) is still unclear. We conducted a case-control study to assess the association between various markers of inflammation and the presence an d severity of chronic stable CHD. We included 312 clinically stable patient s with angiographically documented CHD, aged 40 to 68 years. Voluntary bloo d donors (n = 479) matched for age and gender served as controls. High-sens itivity C-reactive protein, serum amyloid A, plasminogen activator inhibito r-1 activity, von Willebrond factor, fibrinogen, plasma viscosity, albumin, and neutrophils were determined. The severity of CHD was evaluated by 3 co ronary scoring systems: the clinical 1- to 3-vessel disease score, the Amer ican Heart Association extension score (1 to 15 segments), and the Gensini score. All markers of inflammation were highly significantly elevated (all p <0.005) in patients with stable CHD compared with controls. After multiva riable adjustment by means of logistic regression analysis, the association between CHD and fibrinogen, plasma viscosity, van Willebrand factor, and p lasminogen activator inhibitor-1 activity remained substantial, whereas it decreased in high-sensitivity C-reactive protein, serum amyloid A, and neut rophils. The combination of <greater than or equal to>2 markers of inflamma tion was associated with a strongly increased risk of CHD. No association b etween markers of inflammation and any of the coronary scores applied was f ound. These results document an independent association between most of the markers of inflammation and chronic CHD, even in clinically stable patient s. The combination of several of these biochemical markers, i.e., the deter mination of an "inflammatory risk profile," may be useful to further strati fy cardiovascular risk. (C) 2001 by Excerpta Medico, Inc.