Fatality of acute coronary events in relation to hypertension and low-grade inflammation: a population-based cohort study

Abstract

Hypertension has been associated with increased casefatality rates among individuals who subsequently suffer from acute coronary events. It is unknown whether inflammation modifies this relationship. This population-based study explored the effects of inflammation and hypertension on incidence of coronary event, and on the fatality of the future events. Blood pressure (BP) and five inflammation-sensitive plasma proteins (ISPs, fibrinogen, orosomucoid, a1-antitrypsin, haptoglobin and ceruloplasmin) were determined in 6071 healthy men. During the mean follow-up of 19 years, 679 men had a first coronary event (non-fatal myocardial infarction or death from coronary heart disease). Of them, 197 (29%) were fatal cases (death during the first day). As expected, hypertension was associated with increased incidence of coronary events and increased proportion of fatal cases. At all levels of BP, high ISPs (X2 ISPs in top quartile) significantly added to the incidence of events. Men with high ISPs had the highest case-fatality rates. The difference in case-fatality rate between men with and without high ISPs was, however, significant only in men with normal BP (o130/85 mm Hg) (33 vs 19%, Po0.05), and not in men with moderate or severe hypertension (X160/100 mm Hg) (40 vs 35%, P ¼ 0.32). High ISPs add to the incidence of coronary events at all levels of BP. Hypertension and inflammation are both independently associated with increased case-fatality in subjects who later have an acute coronary event. The influence of ISPs on the case-fatality rate seems to be most important in men with normal BP.

Red cell distribution width in relation to incidence of coronary events and case fatality rates: a population-based cohort study

“…Several population-based studies have reported increased case-fatality in individuals with a history of hypertension 9 10 19. Low grade inflammation9 20 21 and diabetes22 23 are other cardiovascular risk factors which have been associated with increased case-fatality in population studies. According to the present results, RDW is another factor which is associated with fatal CE.…”

“…To identify individuals with high risk and prevent the out-of-hospital deaths is a major challenge for healthcare. Previous studies have shown that the patterns of risk factors are different for fatal and non-fatal CE,8 and certain risk factors, for example, hypertension and inflammation, particularly increase the risk of CEs with fatal outcome 9 10. High RDW has been associated with worse prognosis in subjects with clinically manifest coronary artery disease, but there are limited data from population-based studies of incidence and case fatality, including subjects who died out-of-hospital.…”

Association between serum values of C-reactive protein and cytokine production in whole blood of patients with Type 2 diabetes

“…It has been demonstrated that inflammation plays an important role in atherosclerosis [2] and in the pathogenetic mechanisms of some cardiovascular events [3]. Increasing evidence indicates that the same 'traditional' cardiovascular risk factors, such as hypertension, diabetes, obesity, smoking and dyslipidaemia, might induce a 'low-grade' inflammation state through the stimulation of different cytokines [4][5][6].…”

New insights into complement C3 and inflammation in hypertension

“…Gaps still remain in our understanding of the precise pathophysiological mechanism(s) on how various risk factors such as hypertension, hypercholesterolaemia and diabetes lead to the development of atherosclerosis 3 or acute vascular events, but inflammation may prove the missing link. 12 In a recent population-based study of 6071 healthy men followed-up of 19 years, hypertension and inflammation are both independently associated with increased case fatality in the subjects who later had an acute coronary event. 12 Abnormal coagulation/fibrinolytic mechanisms may also be influenced, as inflammation may 'drive' the prothrombotic state associated with hypertension.…”

“…12 In a recent population-based study of 6071 healthy men followed-up of 19 years, hypertension and inflammation are both independently associated with increased case fatality in the subjects who later had an acute coronary event. 12 Abnormal coagulation/fibrinolytic mechanisms may also be influenced, as inflammation may 'drive' the prothrombotic state associated with hypertension. 13 In atherosclerosis, there is good epidemiological, laboratory and clinical data to confirm the presence of chronic inflammation in the vessel wall.…”