Prognostic significance of proinflammatory factors in patients with progressive angina pectoris and type 2 diabetes mellitus
https://doi.org/10.14341/2072-0351-5536
Abstract
Aims.
Our study was aimed to assess the influence of non-specific inflammation and endothelial dysfunction on developmentof cardiovascular events in patients with type 2 diabetes mellitus (T2DM) and progressive angina pectoris.
Materials and methods.
140 patients (63 of them were also diabetic) received follow-up for cardiovascular events during12 months after an episode of unstable angina pectoris. Upon hospitalization for acute coronary syndrome analyses wereperformed to assess the degree of systemic inflammation evaluating plasma concentration of pro- and anti-inflammatorymarkers (CRP, fibrinogen, IL-6, -8, -10, TNF-?), as well as blood glucose and glycated haemoglobin HbA1c.
Results.
TNF-? and IL-6 levels were significantly higher in patients with unfavorable prognosis (p<0.05). On the contrary,an anti-inflammatory IL-10 was found to be more active in patients with better cardiovascular prognosis (p<0.05). Diabeticindividuals were characterized with statistically significant elevation of CRP and fibrinogen, as compared to non-diabeticcontrols. We show a correlation of glycemic parameters, evaluated at 10th day of inpatient care, with IL-6 and CRP.We also established a strong correlation between markers of dyslipidemia and inflammation, evaluated at 10th day ofhospitalization for cardiovascular event in patients with unfavorable prognosis, which suggests common nature of differentmechanisms of atherosclerosis progression.
Our study was aimed to assess the influence of non-specific inflammation and endothelial dysfunction on developmentof cardiovascular events in patients with type 2 diabetes mellitus (T2DM) and progressive angina pectoris.
Materials and methods.
140 patients (63 of them were also diabetic) received follow-up for cardiovascular events during12 months after an episode of unstable angina pectoris. Upon hospitalization for acute coronary syndrome analyses wereperformed to assess the degree of systemic inflammation evaluating plasma concentration of pro- and anti-inflammatorymarkers (CRP, fibrinogen, IL-6, -8, -10, TNF-?), as well as blood glucose and glycated haemoglobin HbA1c.
Results.
TNF-? and IL-6 levels were significantly higher in patients with unfavorable prognosis (p<0.05). On the contrary,an anti-inflammatory IL-10 was found to be more active in patients with better cardiovascular prognosis (p<0.05). Diabeticindividuals were characterized with statistically significant elevation of CRP and fibrinogen, as compared to non-diabeticcontrols. We show a correlation of glycemic parameters, evaluated at 10th day of inpatient care, with IL-6 and CRP.We also established a strong correlation between markers of dyslipidemia and inflammation, evaluated at 10th day ofhospitalization for cardiovascular event in patients with unfavorable prognosis, which suggests common nature of differentmechanisms of atherosclerosis progression.
About the Authors
Olga Leonidovna Barbarash
Research Institute for complex issues of cardiovascular diseases, Kemerovo; Kemerovo State Medical Academy, Kemerovo
Aleksey Nikolaevich Sumin
Research Institute for complex issues of cardiovascular diseases, Kemerovo
Olesya Evgen'evna Avramenko
Research Institute for complex issues of cardiovascular diseases, Kemerovo
Anastasia Vyacheslavovna Osokina
Research Institute for complex issues of cardiovascular diseases, Kemerovo
Aleksey Vladimirovich Veremeev
Research Institute for complex issues of cardiovascular diseases, Kemerovo
References
1. Rydén L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, de Boer MJ, Cosentino F, Jönsson B, Laakso M, Malmberg K, Priori S, Ostergren J, Tuomilehto J, Thrainsdottir I, Vanhorebeek I, Stramba-Badiale M, Lindgren P, Qiao Q, Priori SG, Blanc JJ, Budaj A, Camm J, Dean V, Deckers J, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo J, Zamorano JL, Deckers JW, Bertrand M, Charbonnel B, Erdmann E, Ferrannini E, Flyvbjerg A, Gohlke H, Juanatey JR, Graham I, Monteiro PF, Parhofer K, Pyörälä K, Raz I, Schernthaner G, Volpe M, Wood D; Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC); European Association for the Study of Diabetes (EASD). Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J. 2007 Jan;28(1):88- 136.
2. Arenillas JF, Candell-Riera J, Romero-Farina G, Molina CA, Chacón P, Aguadé-Bruix S, Montaner J, de León G, Castell-Conesa J, Alvarez-Sabín J. Silent myocardial ischemia in patients with symptomatic intracranial atherosclerosis: associated factors. Stroke. 2005 Jun;36(6):1201-1206. Epub 2005 May 5.
3. Gerber Y, Tanne D, Medalie JH, Goldbourt U. Serum uric acid and long-term mortality from stroke, coronary heart disease and all causes Eur J Cardiovasc Prev Rehabil. 2006 Apr;13(2):193-198.
4. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, Fadl YY, Fortmann SP, Hong Y, Myers GL, Rifai N, Smith SC Jr, Taubert K, Tracy RP, Vinicor F; Centers for Disease Control and Prevention; American Heart Association. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003 Jan 28;107(3):499-511.
5. Rader DJ. Inflammatory markers of coronary risk. N Engl J Med. 2000 Oct 19;343(16):1179-1182.
6. Başaran Y, Başaran MM, Babacan KF, Ener B, Okay T, Gök H, Ozdemir M. Serum tumor necrosis factor levels in acute myocardial infarction and unstable angina pectoris. Angiology. 1993 Apr;44(4):332-337.
7. Berezhnaya NM. Cytokine network regulation in pathology: rapid progress in knowledge and inevitable questions. Cytokines and Inflammation. 2007; 6(2):26-34. [Russian]
8. Zorina VN, Trofimenko NA, Arkhipova SV, Zorina RM, Zorin NA. Alpha-2-macroglobulin complexes with IgG antibodies, plasmin, and their interrelation with other factors of humoral immunity during the development of rheumatoid arthritis. Med. Immunol, 2005;7(5-6):557-562. [Russian]
9. Oganov RG, Zakirova NE, Zakirova AN, Salakhova GM, Plotnikova MR. Immuno-inflamatory responses in acute coronary syndrome. Rational Pharmacother. Card. 2007;5:15-19. [Russian]
10. Apple FS, Wu AH, Mair J, Ravkilde J, Panteghini M, Tate J, Pagani F, Christenson RH, Mockel M, Danne O, Jaffe AS; Committee on Standardization of Markers of Cardiac Damage of the IFCC. Future biomarkers for detection of ischemia and risk stratification in acute coronary syndrome. Clin Chem. 2005 May;51(5):810-824. Epub 2005 Mar 17.
11. Shevchenko OD, Mishnev AO, Shevchenko OP. Ishemicheskaya bolezn' serdtsa. Moscow: Reafarm; 2005. 416 p. [Russian]
12. Behrendt D, Ganz P. Endothelial function. From vascular biology to clinical applications Am J Cardiol. 2002 Nov 21;90(10C):40L-48L.
13. Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994 Nov 19;344(8934):1383-1389.
14. Kannel WB, Abbott RD. Incidence and prognosis of unrecognized myocardial infarction: an update on the Framingham study. N Engl J Med. 1984 Nov 1;311(18):1144-1147.
15. Ryabykina GV. Diagnostika ishemii miokarda metodom kholterovskogo monitorirovaniya EKG. Vestnik aritmologii. 2002; (26):5-10. [Russian]
16. Alexandraki K, Piperi C, Kalofoutis C, Singh J, Alaveras A, Kalofoutis A. Inflammatory process in type 2 diabetes: the role of cytokines. Ann N Y Acad Sci. 2006 Nov;1084:89- 117.
17. King DE, Mainous AG 3rd, Buchanan TA, Pearson WS. C - reactive protein and glycemic control in adult with diabetes. Diabetes Care. 2003 May;26(5):1535-1539.
18. Bartnik M, Rydén L, Ferrari R, Malmberg K, Pyörälä K, Simoons M, Standl E, Soler-Soler J, Ohrvik J; Euro Heart Survey Investigators. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. Eur Heart J. 2004 Nov;25(21):1880-1890.
19. Shah PK, Sharifi B. Insights into the molecular mechanisms of plaque rupture and thrombosis. Biochemistry of Atherosclerosis. New York: Springer; 2006. Р. 455-563.
20. Titov VN. Obshchnost' ateroskleroza i vospaleniya: spetsifichnost' ateroskleroza kak vospalitel'nogo protsessa. Rossiyskiy kardiologicheskiy zhurnal. 1999;(5): 48-56.
21. Barbarash LS, Kashtalap VV, Zykov MV, Usol'tseva EN, Iakubik GG, Karetnikova VN, Kudryavtseva IA, Barbarash OL. Prevalence and clinical value of multifocal atherosclerosis in patients with myocardial infarction and ST segment elevation. Cardiology & cardiovascular surgery. 2010;(5): 31-36. [Russian]
22. Roitman EV, Azizova OA, Aseichev AV, Morozov YA. Effect of oxidized fibrinogens on blood coagulation. Bulletin of Experimental Biology and Medicine. 2004;(9): 277-279.
23. Szodoray P, Timar O, Veres K, Der H, Szomjak E, Lakos G, Aleksza M, Nakken B, Szegedi G, Soltesz P. TH1/TH2 imbalance, measured by circulating and intracytoplasmic inflammatory cytokines-immunological alterations in acute coronary syndrome and stable coronary artery disease. Scand J Immunol. 2006 Sep;64(3):336-344.
24. Bode JG, Fischer R, Häussinger D, Graeve L, Heinrich PC, Schaper F. The inhibitory effect of IL-1 beta on IL-6-induced alpha 2-macroglobulin expression is due to activation of NF-kappa B. J Immunol. 2001 Aug 1;167(3):1469-1481.
Review
For citations:
Barbarash O.L., Sumin A.N., Avramenko O.E., Osokina A.V., Veremeev A.V. Prognostic significance of proinflammatory factors in patients with progressive angina pectoris and type 2 diabetes mellitus. Diabetes mellitus. 2012;15(4):39-45. (In Russ.) https://doi.org/10.14341/2072-0351-5536
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