C-reactive protein, prothrombotic imbalance and endothelial dysfunction in acute coronary syndromes without ST elevation.

UNLABELLED: Inflammation is considered a crucial step in the pathogenesis of acute coronary syndromes (ACS). C-reactive protein (CRP) is proposed to be included in risk stratification of ACS patients. However, it is not yet known if CRP is only a risk marker, or merely a risk factor in the development of ACS. Our study looked at the links between inflammation and the prothrombotic factors present in patients with ACS without ST elevation. MATERIAL AND METHODS: 86 patients (pts), 46 men (53.4%), mean age = 58.2+/-12.4 years-old, with acute coronary syndromes (unstable angina and NSTEMI). The following parameters were measured in all pts on admission: CRP, fibrinogen, blood white cell count, and coagulation parameters: coagulation factor V and VIII, von Willebrand factor (vWf), antithrombin III (AT III), D-dimers (DD), C and S proteins. RESULTS: Mean CRP in the study group was 22.42+/-19.81 mg/dl (limits 1.40-88.8 mg/dl). We worked with quartiles of CRP plasmatic levels, in order to see how magnitude of inflammation correlates with different coagulation and fibrinolysis parameters. When comparing the 1st with the 4th CRP quartiles, we noted that important inflammation (4th quartile) was associated with higher factor von Willebrand (141.3 vs 108.9%, p<0.05), factor 5 (127.5% vs 88%, p<0.01), factor 8 (121.5 vs 117.1%, p=0.04), lower AT III (101.6 vs 118.2%, p<0.05), lower protein C and S. The associations did not keep for PAI-I or D-dimers, which might be associated with the lack of sensibility of fibrinolysis markers in the early period after thrombosis. CONCLUSIONS: Inflammation, as quantified by CRP, appears to be associated with a significant prothrombotic status and endothelial dysfunction (as reflected by high von Willebrand factor).

Subclinical atherosclerosis, carotid intima-media thickness and the cardiovascular risk.

The refinement and the improvement of the cardiovascular risk factors assessment became one of the high priorities in the global approach of cardiovascular diseases. Recent studies showed that increased carotid intima media thickness (IMT) is a relatively simple noninvasive marker of the global atherosclerotic disease, even in the asymptomatic stage. There is a strong link between IMT and both traditional and emerging cardiovascular risk factors, and IMT also predicts the occurrence of major cardiovascular events. Thus, IMT, as a marker of subclinical atherosclerosis, might improve the risk assessment in asymptomatic patients at risk.