Studies have shown disparate results in relation to the role of plasma concentrations of
cell adhesion molecules in
atherosclerosis. Moreover, the differentiation of primary vs secondary alterations of these markers, in response to myocardial injury, has not been clear. We measured specific soluble
cell adhesion molecules and inflammatory markers in men admitted acutely with
chest pain and compared them to healthy controls.
METHODS AND RESULTS: We prospectively studied men (total n=241), admitted acutely with
chest pain (7.4+/-9.4 h, 71% within 10 h),
unstable angina (n=67), acute
myocardial infarction (n=47) and
chest pain without ischaemic
heart disease (n=45) and compared them with a stratified sample of randomly selected healthy controls (n=82). Soluble
intercellular adhesion molecule (sICAM-1), endothelial
selectin,
vascular cell adhesion molecule,
interleukin-6 and
C-reactive protein were measured by ELISA and
P-selectin expression by flow cytometry. Multiple regression analysis was used to control for the impact of classical risk factors. At baseline
ICAM-1,
interleukin-6 and
C-reactive protein were significantly elevated in patient groups whereas no difference in
vascular cell adhesion molecule or endothelial
selectin was found. At 3 month follow-up,
ICAM-1 level was unchanged in ischaemic
heart disease patients. In all groups
C-reactive protein and
interleukin-6 levels were lower at review.
ICAM-1 levels at follow-up were higher in ischaemic
heart disease groups (but not in
chest pain without ischaemic
heart disease) relative to controls and remained so only in the
unstable angina group following regression. sICAM-1,
interleukin-6 and
C-reactive protein strongly correlated with smoking. In the acute phase,
ICAM-1 was confounded by smoking following regression and
C-reactive protein and
interleukin-6 remained significant in both ischaemic
heart disease groups after multiple regression. There was no relationship to events which occurred in 23% of ischaemic
heart disease patients (further acute
myocardial infarction 5.3%,
sudden cardiac death 0.9% or recurrent angina 16.7%).
CONCLUSION: