Serial Changes in Circulating Concentrations of Soluble CD40 Ligand and C-Reactive Protein in Patients With Unstable Angina Undergoing Coronary Stenting Role of Inflammatory Mediators in Predicting Late Restenosis

Abstract

Background This study tested the hypothesis that serum concentrations of high-sensitivity C-reactive protein (hs-CRP) and soluble CD40 ligand (sCD40L) significantly reflect serial changes in patients with unstable angina, and thus the serum concentrations of these inflammatory biomarkers may be good candidates for predicting late restenosis after coronary stenting. Methods and ResultsThe circulating concentrations of sCD40L and hs-CRP were prospectively measured (both pre-procedure, and on days 21, 90, and 180 after the procedure) in 77 consecutive patients with unstable angina undergoing coronary stenting. These inflammatory mediators were also evaluated in 30 healthy volunteers. The serum concentrations of sCD40L and hs-CRP were significantly higher pre-procedure in study patients than in normal control subjects (all p values <0.0001). These inflammatory markers then declined to a substantially lower concentration by day 21 (all p values <0.05). Circulating concentrations of hs-CRP in each patient then differed little from each other afterwards. However, the sCD40L concentration was once again raised significantly on days 90 and 180 as compared to day 21 (both p values <0.05). This study found no significant link between raised circulating concentrations of sCD40L and hs-CRP and late restenosis. Conclusions Circulating concentrations of sCD40L and hs-CRP were significantly increased in unstable angina patients pre-procedure and declined substantially thereafter. However, the circulating concentrations of these 2 inflammatory mediators were not useful in predicting late restenosis following coronary stenting. (Circ J 2005; 69: 890 -895)

Re-Elevation of High-Sensitivity C-Reactive Protein but not the von Willebrand Factor After Withdrawing Atorvastatin Therapy in Patients With Unstable Angina Undergoing Coronary Artery Stenting A Kinetic Study

“…These 2 inflammatory biomarkers reflect the fact that the study patients had an ongoing inflammatory process. Therefore, our findings are consistent with recent studies 6,7,12,18,19) and further support the finding that CRP, an index of inflammation, has a proatherosclerotic effect and promotes the atherosclerotic process. 4,10,16,[18][19][20] One of the important findings of this study was that the circulating level of hs-CRP rapidly and significantly declined on day 30 following the procedure.…”

“…Thus, these findings further support those obtained by recent studies. 7,12) The most important finding in this study was that levels of hs-CRP and total cholesterol increased significantly 3 months after withdrawing the atorvastatin therapy. Therefore, these findings expand upon those in previous and recent studies 7,12,13) and encourage the continuous use of statin therapy for high-risk patient subgroups for primary or secondary prevention.…”

“…13) At present, data regarding the time course of hs-CRP levels are still limited. 7,12) Additionally, data concerning circulating levels of hs-CRP after stopping statin therapy remain uncertain. This study demonstrated a kinetic change in circulating levels of hs-CRP following stenting and atorvastatin therapy.…”

“…4) Recently, we have demonstrated that circulating concentrations of high-sensitivity (hs)-CRP were significantly increased in unstable angina patients before coronary stenting and declined more substantially in patients with than in patients without statin therapy after coronary stetning. 12) Additionally, a previous study 13) showed that high-dose atorvastatin induced a strong reduction in hs-CRP levels that was mainly independent of lipid lowering in type II diabetes mellitus patients. Thus, the action of atorvastatin on inflammation could add to its cardioprotective effect in high-risk patients.…”

Levels of Circulating Neopterin in Patients with Severe Carotid Artery Stenosis Undergoing Carotid Stenting

“…Numerous studies have shown that inflammatory biomarkers play a pivotal role in the risk stratification and prediction of clinical outcomes in patients with acute coronary syndrome [1][2][3][4][5] . Immunohistochemical staining of atherosclerotic lesions further demonstrates Yung-Lung Chen and Tzu-Hsien Tsai contributed equally to this work.…”