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Comparison of C-reactive protein and terminal complement complex in patients with unstable angina pectoris versus
Hans Martin Hoffmeister1, Raila Ehlers, Evi Büttcher
1Klinik für Kardiologie und Allgemeine Innere Medizin, Stäedtisches Klinikum Solingen, Solingen, Germany. hoffmeister@klinikumsolingen.de
Insights
Elevated C-reactive protein (CRP) indicates a higher risk of acute events in coronary artery disease. This study links high CRP to terminal complement system activation in unstable angina, explaining CRP's prognostic value in acute coronary syndromes.
Area of Science:
- Cardiology
- Immunology
- Biochemistry
Background:
- Elevated C-reactive protein (CRP) is a known predictor of future acute events in patients with coronary artery disease.
- The prognostic significance of CRP in acute coronary syndromes (ACS) warrants further investigation into its underlying mechanisms.
Purpose of the Study:
- To investigate the relationship between elevated CRP and the activation of the terminal complement cascade.
- To explore the role of the terminal complement complex (sC5b-9) in patients with unstable angina pectoris (UAP).
Main Methods:
- Measured CRP, acute phase reactants, terminal complement complex (sC5b-9), leukocytes, and troponin T in 66 UAP patients, 45 stable angina patients, and 42 controls.
- Categorized UAP patients based on elevated CRP levels (>0.3 mg/dl).
- Analyzed plasma levels of sC5b-9 in relation to CRP levels and clinical groups.
Main Results:
- Patients with UAP and elevated CRP showed significantly higher plasma sC5b-9 levels compared to UAP patients with lower CRP and stable angina patients.
- A further acute phase reaction was predominantly observed in UAP patients with elevated CRP upon admission.
- sC5b-9 levels were not correlated with troponin release.
Conclusions:
- Elevated CRP in UAP is associated with the activation of the terminal complement system, which may destabilize atherosclerotic plaques.
- This complement system activation during the acute phase reaction could explain the prognostic value of CRP in ACS.
- The findings highlight a potential mechanism linking inflammation and thrombosis in acute coronary events.
Abstract:
Elevated C-reactive protein (CRP) can identify patients with coronary artery disease who are prone to future acute events. We investigated whether elevated CRP is related to the activation of the terminal complement cascade in 66 patients with unstable angina pectoris (UAP), in 45 patients with stable angina pectoris, and in 42 controls. CRP, additional acute phase reactants, the terminal complement complex (sC5b-9), leukocytes, and troponin T were measured. In 47 patients with UAP the CRP values were regarded as elevated (>0.3 mg/dl). In patients with UAP and elevated CRP, the plasma levels of sC5b-9 were markedly higher than in patients with UAP and lower CRP (245 +/- 14 vs 188 +/- 19 ng/ml, p <0.02) and in patients with stable angina pectoris with slightly (0.4 +/- 0.1 mg/dl) increased CRP (sC5b-9 173 +/- 21 vs 130 +/- 7 ng/ml [controls; p <0.05]). A further acute phase reaction was present only in patients with UAP and elevated CRP already on admission (p <0.01). sC5b-9 was not related to troponin release. Thus, elevated CRP levels are associated with activation of the plaque destabilizating terminal complement system in patients with UAP during the acute phase reaction. This may explain the prognostic value of CRP in acute coronary syndromes (ACS).