Advertisement

Patients with a history of stable or unstable coronary heart disease have different acute phase responses to an inflammatory stimulus

      Abstract

      Increased levels of acute phase proteins (APP) in serum are associated with vulnerability of atherosclerotic plaques and acute manifestations of coronary heart disease (CHD). APP have been viewed as indexes of active vascular inflammation or as mediators of atherothrombosis. In the present study we tested the hypothesis that individuals who develop stable or unstable forms of CHD might have different innate responses to an inflammatory stimulus.
      We compared changes in plasma C-reactive protein (CRP) and serum amyloid A (SAA) concentrations 48 h after a standardized inflammatory stimulus (adjuvanted influenza vaccination) in patients with quiescent CHD that had been manifested at onset as inducible myocardial ischemia (Group 1, n = 26) or as acute coronary syndromes (ACS) (Group 2, n = 34). Selected patients were free from inflammatory or other conditions that might affect the immune response.
      CRP concentration increased significantly after vaccination in both groups (Group 1: 0.47 [0.21–0.86] to 0.56 [0.32–1.17] mg/L, p = 0.005; Group 2: 0.64 [0.21–1.09] to 0.75 [0.33–1.48] mg/L, p = 0.003), without significant differences between groups in absolute or percentage changes. By contrast, SAA did not change after vaccination in Group 1 (14.4 [8.9–19.5] to 14.8 [10.3–18.8] mg/L, p = 0.88) but increased significantly in Group 2 (16.9 [10.0–21.5] to 19.2 [11.3–29.1] mg/L, p = 0.002), with significant differences between the groups in absolute and percentage terms (p = 0.015 and 0.019, respectively). Changes in CRP and SAA, both absolute and percentage, were significantly correlated in Group 2 (r = 0.60 and 0.66, both p < 0.001). The responsiveness of plasma SAA to an inflammatory stimulus in Group 2 alone suggests a pro-inflammatory status in patients prone to acute coronary syndrome but not in those with inducible myocardial ischemia.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ross R.
        Atherosclerosis—an inflammatory disease.
        N Engl J Med. 1999; 340: 115-126
        • Libby P.
        • Ridker P.M.
        • Maseri A.
        Inflammation and atherosclerosis.
        Circulation. 2002; 105: 1135-1143
        • Ikeda U.
        Inflammation and coronary artery disease.
        Curr Vasc Pharmacol. 2003; 1: 65-70
        • Lombardo A.
        • Biasucci L.M.
        • Lanza G.A.
        • et al.
        Inflammation as a possible link between coronary and carotid plaque instability.
        Circulation. 2004; 109: 3158-3163
        • Meuwissen M.
        • van der Wal A.C.
        • Niessen H.W.
        • et al.
        Colocalisation of intraplaque C reactive protein, complement, oxidised low density lipoprotein, and macrophages in stable and unstable angina and acute myocardial infarction.
        J Clin Pathol. 2006; 59: 196-201
        • Amento E.P.
        • Ehsani N.
        • Palmer H.
        • et al.
        Cytokines positively and negatively regulate interstitial collagen gene expression in human vascular smooth muscle cells.
        Arteriosclerosis. 1991; 11: 1223-1230
        • Herman M.P.
        • Sukhova G.K.
        • Libby P.
        • et al.
        Expression of neutrophil collagenase (matrix metalloproteinase-8) in human atheroma: a novel collagenolytic pathway suggested by transcriptional profiling.
        Circulation. 2001; 104: 1899-1904
        • Ballou S.P.
        • Lozanski G.
        Induction of inflammatory cytokine release from cultured human monocytes by C-reactive protein.
        Cytokine. 1992; 4: 361-368
        • Cermak J.
        • Key N.S.
        • Bach R.R.
        • Balla J.
        • Jacob H.S.
        • Vercellotti G.M.
        C-reactive protein induces human peripheral blood monocytes to synthesize tissue factor.
        Blood. 1993; 82: 513-520
        • Pasceri V.
        • Willerson J.T.
        • Yeh E.T.
        Direct proinflammatory effect of C-reactive protein on human endothelial cells.
        Circulation. 2000; 102: 2165-2168
        • Singh U.
        • Devaraj S.
        • Jialal I.
        C-reactive protein decreases tissue plasminogen activator activity in human aortic endothelial cells: evidence that C-reactive protein is a procoagulant.
        Arterioscler Thromb Vasc Biol. 2005; 25: 2216-2221
        • Banka C.L.
        • Yuan T.
        • de Beer M.C.
        • Kindy M.
        • Curtiss L.K.
        • de Beer F.C.
        Serum amyloid A (SAA): influence on HDL-mediated cellular cholesterol efflux.
        J Lipid Res. 1995; 36: 1058-1065
        • Berliner J.A.
        • Navab M.
        • Fogelman A.M.
        • et al.
        Atherosclerosis: basic mechanism–oxidation, inflammation and genetics.
        Circulation. 1995; 91: 2488-2496
        • Ridker P.M.
        • Cushman M.
        • Stampfer M.J.
        • Tracy R.P.
        • Hennekens C.H.
        Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men.
        N Engl J Med. 1997; 336: 973-979
        • Biasucci L.M.
        • Liuzzo G.
        • Grillo R.L.
        • et al.
        Elevated levels of C-reactive protein at discharge in patients with unstable angina predict recurrent instability.
        Circulation. 1999; 99: 855-860
        • Morrow D.A.
        • Rifai N.
        • Antman E.M.
        • et al.
        Serum amyloid A predicts early mortality in acute coronary syndromes: a TIMI 11A substudy.
        J Am Coll Cardiol. 2000; 35: 358-362
        • Renvert S.
        • Pettersson T.
        • Ohlsson O.
        • Persson G.R.
        Bacterial profile and burden of periodontal infection in subjects with a diagnosis of acute coronary syndrome.
        J Periodontol. 2006; 77: 1110-1119
        • Hoshida S.
        • Nishino M.
        • Tanouchi J.
        • Kishimoto T.
        • Yamada Y.
        Acute Chlamydia pneumoniae infection with heat-shock-protein-60-related response in patients with acute coronary syndrome.
        Atherosclerosis. 2005; 183: 109-112
        • Sims J.B.
        • de Lemos J.A.
        • Maewal P.
        • Warner J.J.
        • Peterson G.E.
        • McGuire D.K.
        Urinary tract infection in patients with acute coronary syndrome: a potential systemic inflammatory connection.
        Am Heart J. 2005; 149: 1062-1065
        • Malle E.
        • De Beer F.C.
        Human serum amyloid A (SAA) protein: a prominent acute-phase reactant for clinical practice.
        Eur J Clin Invest. 1996; 26: 427-435
        • Gabay C.
        • Kushner I.
        Acute-phase proteins and other systemic responses to inflammation.
        N Engl J Med. 1999; 340: 448-454
        • Posthouwer D.
        • Voorbij H.A.
        • Grobbee D.E.
        • Numans M.E.
        • van der Bom J.G.
        Influenza and pneumococcal vaccination as a model to assess C-reactive protein response to mild inflammation.
        Vaccine. 2004; 23: 362-365
        • Tsai M.Y.
        • Hanson N.Q.
        • Straka R.J.
        • et al.
        Effect of influenza vaccine on markers of inflammation and lipid profile.
        J Lab Clin Med. 2005; 145: 323-327
        • Nilson J.
        CRP-Marker or Maker of cardiovascular disease?.
        Arterioscler Thromb Vasc Biol. 2005; 25: 1527-1528
        • Whicher J.T.
        • Chambers R.E.
        • Higginson J.
        • Nashef L.
        • Higgins P.G.
        Acute phase response of serum amyloid A protein and C reactive protein to the common cold and influenza.
        J Clin Pathol. 1985; 38: 312-316
        • Lannergard A.
        • Larsson A.
        • Kragsbjerg P.
        • Friman G.
        Correlations between serum amyloid A protein and C-reactive protein in infectious diseases.
        Scand J Clin Lab Invest. 2003; 63: 267-272
        • Gaspardone A.
        • Versaci F.
        • Proietti I.
        • et al.
        Effect of atorvastatin (80 mg) initiated at the time of coronary artery stent implantation on C-reactive protein and six-month clinical events.
        Am J Cardiol. 2002; 90: 786-789
        • Brull D.J.
        • Sanders J.
        • Rumley A.
        • Lowe G.D.
        • Humphries S.E.
        • Montgomery H.E.
        Statin therapy and the acute inflammatory response after coronary artery bypass grafting.
        Am J Cardiol. 2001; 88: 431-433
        • Liuzzo G.
        • Buffon A.
        • Biasucci L.M.
        • et al.
        Enhanced inflammatory response to coronary angioplasty in patients with severe unstable angina.
        Circulation. 1998; 98: 2370-2376
        • Cusack M.R.
        • Marber M.S.
        • Lambiase P.D.
        • Bucknall C.A.
        • Redwood S.R.
        Systemic inflammation in unstable angina is the result of myocardial necrosis.
        J Am Coll Cardiol. 2002; 39: 1917-1923
        • Bernstein E.D.
        • Gardner E.M.
        • Abrutyn E.
        • Gross P.
        • Murasko D.M.
        Cytokine production after influenza vaccination in a healthy elderly population.
        Vaccine. 1998; 16: 1722-1731
        • Liuzzo G.
        • Biasucci L.M.
        • Gallimore J.R.
        • et al.
        The prognostic value of C-reactive protein and serum amyloid a protein in severe unstable angina.
        N Engl J Med. 1994; 331: 417-424
        • Lee W.H.
        • Lee Y.
        • Jeong J.O.
        • Lee S.Y.
        • Choi Y.H.
        • Park J.E.
        Activation of CD14 on circulating monocytes in patients with acute coronary syndrome.
        Int J Cardiol. 2001; 80: 135-142
        • Nijm J.
        • Wikby A.
        • Tompa A.
        • Olsson A.G.
        • Jonasson L.
        Circulating levels of proinflammatory cytokines and neutrophil-platelet aggregates in patients with coronary artery disease.
        Am J Cardiol. 2005; 95: 452-456
        • Kharbanda R.K.
        • Walton B.
        • Allen M.
        • et al.
        Prevention of inflammation-induced endothelial dysfunction: a novel vasculoprotective action of aspirin.
        Circulation. 2002; 105: 2600-2604
        • van der Beek M.T.
        • Visser L.G.
        • de Maat M.P.M.
        Yellow fever vaccination as a model to study the response to stimulation of the inflammation system.
        Vascul Pharmacol. 2002; 39: 117-121
        • Verschuur M.
        • van der Beek M.T.
        • Tak H.S.
        • Visser L.G.
        • de Maat M.P.
        Interindividual variation in the response by fibrinogen, C-reactive protein and interleukin-6 to yellow fever vaccination.
        Blood Coagul Fibrinolysis. 2004; 15: 399-404
        • Davis M.M.
        • Taubert K.
        • Benin A.L.
        • et al.
        Influenza vaccination as secondary prevention for cardiovascular disease: a science advisory from the American Heart Association/American College of Cardiology.
        J Am Coll Cardiol. 2006; 48: 1498-1502
        • Liuzzo G.
        • Angiolillo D.J.
        • Buffon A.
        • et al.
        Enhanced response of blood monocytes to in vitro lipopolysaccharide-challenge in patients with recurrent unstable angina.
        Circulation. 2001; 103: 2236-2241
        • Kornman K.S.
        • Pankow J.
        • Offenbacher S.
        • Beck J.
        • di Giovine F.
        • Duff G.W.
        Interleukin-1 genotypes and the association between periodontitis and cardiovascular disease.
        J Periodontal Res. 1999; 34: 353-357
        • Kiechl S.
        • Lorenz E.
        • Reindl M.
        • et al.
        Toll-like receptor 4 polymorphisms and atherogenesis.
        N Engl J Med. 2002; 347: 185-192
        • Berger P.
        • McConnell J.P.
        • Nunn M.
        • et al.
        C-reactive protein levels are influenced by common IL-1 gene variations.
        Cytokine. 2002; 17: 171-174
        • Santamaria M.
        • Liuzzo G.
        • Biasucci L.M.
        Genetic modulation in the inflammatory process of ischemic cardiopathy.
        Ital Heart J. 2002; 3: 913-918
        • Poledne R.
        • Setina M.
        • Lorenzova A.
        • Pospisilova H.
        • Stavek R.
        Genetic effect of CRP concentration.
        Atherosclerosis. 2006; 7 ([abst.]): 285
        • Bogaty P.
        • Robitaille N.M.
        • Solymoss S.
        • et al.
        Atherogenic, hemostatic, and other potential risk markers in subjects with previous isolated myocardial infarction compared with long-standing uncomplicated stable angina.
        Am Heart J. 1998; 136: 884-893
        • Carty C.L.
        • Heagerty P.
        • Nakayama K.
        • et al.
        Inflammatory response after influenza vaccination in men with and without carotid artery disease.
        Arterioscler Thromb Vasc Biol. 2006; 26: 2738-2744