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Circulating endothelial progenitor cells and cardiovascular outcomes.
Nikos Werner1, Sonja Kosiol, Tobias Schiegl
1Division of Cardiology, Angiology, and Intensive Care Medicine, Department of Internal Medicine, University of Saarland, Homburg-Saar, Germany.
The New England Journal of Medicine
|September 9, 2005
Summary
Higher levels of circulating endothelial progenitor cells (EPCs) are linked to a lower risk of cardiovascular events and death. Measuring CD34+KDR+ EPCs may help identify patients with increased cardiovascular risk.
Area of Science:
- Cardiovascular Medicine
- Cell Biology
- Regenerative Medicine
Background:
- Endothelial progenitor cells (EPCs) from bone marrow are vital for vascular endothelium integrity.
- EPC number and function inversely correlate with cardiovascular risk factors.
- The prognostic significance of circulating EPCs in cardiovascular disease remains undefined.
Purpose of the Study:
- To determine the prognostic value of circulating endothelial progenitor cells (EPCs) in patients with coronary artery disease.
- To assess the association between baseline EPC levels and major adverse cardiovascular outcomes.
Main Methods:
- Flow cytometry was used to quantify CD34+ and kinase insert domain receptor (KDR)+ EPCs in 519 coronary artery disease patients.
- Patient outcomes, including cardiovascular death, major cardiovascular events, revascularization, and hospitalization, were tracked for 12 months.
Main Results:
- Increased baseline EPC levels correlated with a stepwise increase in event-free survival.
- Higher EPC levels significantly reduced the risk of cardiovascular death (HR 0.31), major cardiovascular events (HR 0.74), revascularization (HR 0.77), and hospitalization (HR 0.76) after multivariable adjustment.
- EPC levels did not predict myocardial infarction or all-cause mortality.
Conclusions:
- Circulating CD34+KDR+ EPC levels serve as a significant predictor of cardiovascular events and death.
- EPC levels can aid in identifying individuals at higher cardiovascular risk.
- This finding supports the clinical utility of EPC enumeration in cardiovascular risk stratification.