N. Van De Veire

Cardiovascular determinants and prognostic significance of CC Chemokine Ligand-18 (CCL18/PARC) in patients with stable coronary artery disease

Chemokines are important mediators of angiogenesis, hematopoiesis and leucocyte trafficking. CC Chemokine Ligand-18 (CCL18)/ pulmonary and activation-regulated chemokine (PARC) is a circulating chemokine that plays a role in injury healing, physiological homing of mononuclear blood cells and inflammatory responses. CCL18/PARC is also expressed in atherosclerotic plaques. We prospectively evaluated CCL18/PARC levels and their cardiovascular and biological determinants in a large cohort of 285 patients with stable coronary heart disease who were subsequently followed for 3 years for hard cardiac events. It was found that CCL18/PARC levels were associated with decreased cardiac function, decreased exercise capacity and increased inflammatory parameters including interleukin-6 (IL-6) and hs-CRP. More importantly high CCL18/PARC levels were an independent predictor of future cardiovascular events. Therefore, CCL18/PARC is a potential diagnostic and prognostic parameter in patients with stable coronary artery disease.

Neurohumoral and inflammatory activation in patients with coronary artery disease treated with statins

Inflammation plays an important part in the pathophysiology of coronary artery disease (CAD).1 High sensitive C reactive protein (hsCRP) reflects activation of the inflammatory system and independently predicts risk of first coronary events at all levels of low density lipoprotein (LDL)-cholesterol and a full spectrum of Framingham risk categories.2 Recent trials indicate that statins reduce inflammation.3,4 This leads to a better clinical outcome and reduces the rate of atherosclerosis progression independently of the reduction in cholesterol levels. The reasons why patients with raised levels of C reactive protein (CRP) have a worse outcome are, however, not clear. The inflammatory biomarkers interleukin 6 (IL6), soluble tumour necrosis factor receptors (sTNFr) 1 and 2 have proinflammatory and procoagulant properties. Our first aim was to evaluate whether high levels of hsCRP in patients with stable CAD receiving standard statin treatment are associated with activation of these biomarkers. Our second aim was to evaluate whether hsCRP and cytokine levels are determined by LDL-cholesterol or by neurohumoral activation measured by levels of N-terminal pro-B type natriuretic peptide (NT-proBNP). We analysed a subgroup of an ongoing prospective study comprising 153 statin treated patients with stable CAD. They were evaluated >6 months from myocardial infarction or cardiac revascularisation, and were free from infection, inflammatory diseases, malignancy and anti-inflammatory treatment. …