Circulation. 2001;104:1336-1342
doi: 10.1161/hc3701.095949
doi: 10.1161/hc3701.095949
(Circulation. 2001;104:1336.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Circulating Cell Adhesion Molecules and Death in Patients With Coronary Artery Disease
From the Department of Medicine II (S.B., H.J.R., C.B., J.M.) and the Department of Clinical Chemistry (D.P., G.H.), Johannes Gutenberg-University Mainz, Germany; and INSERM U525, Faculté de Médecine (L.T.), Paris, France.
Correspondence to Stefan Blankenberg, MD, Department of Medicine II, Johannes Gutenberg-University Mainz, Langenbeckstr 1, 55101 Mainz, Germany. E-mail stefan.blankenberg{at}uni-mainz.de
Background— —Vascular cell adhesion molecule (VCAM)-1, intercellular adhesion molecule (ICAM)-1, and E-selectin mediate adhesion and transmigration of leukocytes to the vascular endothelial wall and may promote plaque growth and instability. In a prospective study, we evaluated the effect of soluble adhesion molecules on the risk of future cardiovascular events among patients with angiographically documented coronary artery disease (CAD).
Methods and Results— —We obtained baseline samples from a prospective cohort of 1246 patients with CAD. Besides various markers of inflammation, soluble VCAM-1 (sVCAM-1), sICAM-1, and sE-selectin were determined. Follow-up information on cardiovascular events was obtained (mean, 2.7; maximum, 4.1 years). Independently higher levels of sVCAM-1 (1932 versus 1128 ng/mL; P<0.0001), sICAM-1 (353 versus 287 ng/mL; P=0.015), and sE-selectin (81 versus 63 ng/mL; P=0.003) were observed in patients with future death from cardiovascular causes. In a multivariate model, fatal risk was 2.1-fold (1.1 to 4.0) higher in patients within the top quartile of baseline sVCAM-1 concentrations compared with lower quartiles. This association was present independent of general inflammatory response as reflected by low or high C-reactive protein (hs-CRP) levels. In a model that simultaneously controlled for all inflammatory and soluble adhesion markers determined, only sVCAM-1 remained independently significant for future fatal cardiovascular events, with a 2.8-fold increase in risk (P=0.003).
Conclusions— —Soluble adhesion molecules sVCAM-1, sICAM-1, and sE-selectin were significantly related to future death from cardiovascular causes among patients with documented CAD. Especially sVCAM-1 added to the predictive value of classic risk factors and hs-CRP in determining the risk of future cardiovascular death.
Key Words: cell adhesion molecules • survival • heart diseases • risk factors • thrombosis
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