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Published on: January 28, 2020
Inflammatory biomarkers in cardiac syndrome X: a systematic review and meta-analysis
Yuexia Zhao1, Arshin Ghaedi2, Pouria Azami3
1Shandong Mental Health Center, Jinan, Shandong Province, China.
Insights
Cardiac Syndrome X (CSX) is associated with elevated inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-a), and platelet-to-lymphocyte ratio (PLR). This meta-analysis confirms a significant increase in these markers in CSX patients compared to healthy individuals.
Area of Science:
- Cardiology
- Immunology
- Biomarker Research
Background:
- Cardiac Syndrome X (CSX) is a condition characterized by chest pain despite normal coronary angiograms.
- The role of inflammation in CSX pathogenesis remains incompletely understood.
- Identifying reliable inflammatory biomarkers could aid in diagnosis and management of CSX.
Approach:
- A systematic review and meta-analysis was conducted, searching major scientific databases for relevant studies.
- Included studies compared inflammatory biomarker levels (NLR, PLR, CRP, TNF-a, IL-6) in CSX patients versus healthy controls.
- Statistical analysis used standardized mean differences (SMD) with 95% confidence intervals (CI) to assess biomarker levels and heterogeneity.
Key Points:
- The analysis included 29 articles with 3480 participants (1855 CSX, 1625 controls).
- Significantly elevated levels of NLR, CRP, IL-6, TNF-a, and PLR were observed in the CSX group compared to healthy controls.
- High heterogeneity was noted for NLR, indicating variability across studies.
Conclusions:
- CSX is significantly associated with increased levels of key inflammatory biomarkers.
- These findings highlight the inflammatory nature of CSX.
- Further research may explore the clinical utility of these biomarkers in CSX management.
Introduction:
In the current systematic review and meta-analysis, we aim to analyze the existing literature to evaluate the role of inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), tumor necrosis factor-a (TNF-a), and interleukin-6 (IL-6) among individuals with cardiac syndrome X (CSX) compared to healthy controls.
Methods:
We used PubMed, Web of Science, Scopus, Science Direct, and Embase to systematically search relevant publications published before April 2, 2023. We performed the meta-analysis using Stata 11.2 software (Stata Corp, College Station, TX). So, we used standardized mean difference (SMD) with a 95% confidence interval (CI) to compare the biomarker level between patients and healthy controls. The I2 and Cochran's Q tests were adopted to determine the heterogeneity of the included studies.
Results:
Overall, 29 articles with 3480 participants (1855 with CSX and 1625 healthy controls) were included in the analysis. There was a significantly higher level of NLR (SMD = 0.85, 95%CI = 0.55-1.15, I2 = 89.0 %), CRP (SMD = 0.69, 95%CI = 0.38 to 1.02, p < 0.0001), IL-6 (SMD = 5.70, 95%CI = 1.91 to 9.50, p = 0.003), TNF-a (SMD = 3.78, 95%CI = 0.63 to 6.92, p = 0.019), and PLR (SMD = 1.38, 95%CI = 0.50 to 2.28, p = 0.02) in the CSX group in comparison with healthy controls.
Conclusion:
The results of this study showed that CSX leads to a significant increase in inflammatory biomarkers, including NLR, CRP, IL-6, TNF-a, and PLR.
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