The relationship of coronary artery disease and indirect inflammatory markers

Öz

Aim: Lipid and inflammatory molecules play important roles in the pathophysiology of atherosclerosis. Recently, a new biomarker called neutrophil/ high density lipoprotein cholesterol (HDL-K) (NHR) composed of neutrophil as a marker of inflammation, and HDL-K as an anti-atherosclerotic lipid have been found to be related with coronary artery disease (CAD). We aimed to find out the clinical pathologies associated with CAD that were related with NHR ratio. Material and Methods: We screened patients that were admitted to our cardiology outpatient clinic with the complaint of chest pain or dyspnea retrospectively. Our study included 226 patients with CAD and 267 patients without CAD, evaluated by myocardial perfusion scintigraphy, multislice computed tomography or coronary angiography (74.8% male, mean age 64.22 ± 6.35; 49.8% male, mean age 61.92 ± 7.32). We calculated the cut-off value of NHR ratio that is related with CAD. Then we evaluated the factors related with increased NHR ratio. Results: We detected higher NHR ratios in CAD (+) group than in CAD (-) group (0.111(0.040-0.420) vs. 0.092(0.030-0.260), p<0.001). A cutoff value of ≥0.106 for the NHR ratio was estimated to evaluate CAD, which had a sensitivity of 61.5% and specificity of 61.4%, AUC: 0.670 with 95% CI (0.623–0.717). We determined that male gender, diabetes mellitus, CAD, peripheral artery disease (PAD) were independent predictors of NHR ≥0.106. Conclusion: Male gender, diabetes mellitus, CAD and PAD were found to be independent predictors of increased NHR ratio. NHR ratio may be used in the evaluation of atherosclerotic cardiovascular diseases

Anahtar Kelimeler

• coronary artery disease
• inflammation
• high density lipoprotion cholesterol

Koroner arter hastalığı ile indirekt inflamatuar belirteçlerin ilişkisi

Öz

Amaç: Ateroskleroz patofizyolojisinde lipit ve inflamatuar moleküller önemli rol oynar. Yakın zamanda yapılan çalışmalarda inflamatuar bir gösterge olan nötrofil sayısı ile yüksek dansiteli lipoproteinden (HDL-K) oluşan nötrofil/HDL-K (NHR) oranının koroner arter hastalığı (KAH) ile ilişkisi gösterilmiştir. Biz de çalışmamızda NHR oranın KAH ile bağlantılı hangi klinik patolojilerle ilişkili olduğunu bulmayı amaçladık. Gereç ve Yöntemler: 01.Eylül.2019-31.Aralık.2019 tarihleri arasında göğüs ağrısı veya nefes darlığı şikayetleri ile kardiyoloji polikliniğimize başvuran hastalar retrospektif olarak tarandı. Miyokart perfüzyon sintigrafisi (MPS), çok kesitli bilgisayarlı tomografi (ÇKBT) veya koroner anjiyografi (KAG) ile değerlendirilen, KAH olan 226 hasta ve KAH olmayan 267 hasta çalışmamıza dahil edildi (%74,8 erkek, ortalama yaş 64,22 ± 6,35; %49,8 erkek, ortalama yaş 61,92 ± 7,32). KAH (+) ve KAH (-) grupları arasında NHR oranı karşılaştırıldı. ROC (Receiver Operating Characteristics) analizi ile KAH ile ilişkili NHR oranının cut-off değeri hesaplandı. Daha sonra yüksek NHR oranı ile ilişkili klinik faktörler değerlendirildi. Bulgular: KAH (+) grupta KAH (-) gruba göre daha yüksek NHR oranları saptandı (0,111 (0,040-0,420) vs. 0,092 (0,030- 0,260), p<0,001) (Tablo 1). NHR oranının 0,106 ve üzerinde olması %61,5 duyarlılık, %61,4 özgüllükle KAH ile ilişkili tespit edildi (EAA: 0,670; %95 GA: 0,623-0,717, p<0,001). Erkek cinsiyet, diyabet, KAH, periferik arter hastalığının (PAH) NHR ≥0,106 ile bağımsız ilişkili olduğu saptandı. Sonuç: Çalışmamızda erkek cinsiyet, diyabetes mellitus (DM), KAH ve PAH’ ın yüksek NHR oranının bağımsız öngördürücüleri olduğu bulundu. Nefes darlığı ve göğüs ağrısı şikayetleri ile kardiyoloji polikliniğine başvuran hastalarda aterosklerotik kardiyovasküler hastalıkların değerlendirilmesinde, lipit profili ve kan sayımından elde edilen parametrelerden kolaylıkla hesaplanabilen NHR oranının da katkı sağlayabileceğini düşünmekteyiz.

Anahtar Kelimeler

• koroner arter hastalığı
• inflamasyon
• yüksek dansiteli lipoprotein kolesterol

Kaynakça

1. 1. Mathur P, Ostadal B, Romeo F, Mehta JL. Gender-Related Differencesin Atherosclerosis. Cardiovasc Drugs Ther 2015; 29: 319-27.
2. 2. Akyel A, Yayla Ç, Erat M et al. Neutrophil-to-lymphocyte ratio predicts hemodynamic significance of coronary artery stenosis. Anatol J Cardiol 2015; 15: 1002-7.
3. 3. Kou T, Luo H, Yin L. Relationship between neutrophils to HDL-C ratio and severity of coronary stenosis. BMC Cardiovasc Disord 2021; 21: 127.
4. 4. Eriksson EE, Xie X, Werr J, Thoren P, Lindbom L. Direct viewing of atherosclerosis in vivo: plaque invasion by leukocytes is initiated by the endothelial selectins. Faseb j. 2001; 15: 1149-57.
5. 5. Ahn N, Kim K. High-density lipoprotein cholesterol (HDL-C) in cardiovascular disease: effect of exercise training. Integr Med Res 2016; 5: 212-5.
6. 6. Williams B, Mancia G, Spiering W et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: Hypertens 2018; 36: 1953-2041.
7. 7. Cosentino F, Grant PJ, Aboyans V et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020; 41: 255-323.
8. 8. Ponikowski P, Voors AA, Anker SD et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016; 37: 2129-200.

9. 9. Aboyans V, Ricco JB, Bartelink MEL et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur Heart J 2018; 39: 763-816.
10. 10. Malakar AK, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S. A review on coronary artery disease, its risk factors, and therapeutics. J Cell Physiol 2019; 234: 16812-23.
11. 11. Lala A, Desai AS. The role of coronary artery disease in heart failure. Heart Fail Clin. 2014; 10: 353-65.
12. 12. Taniguchi H, Momiyama Y, Ohmori R et al. Associations of plasma C-reactive protein levels with the presence and extent of coronary stenosis in patients with stable coronary artery disease. Atherosclerosis 2005; 178: 173-7.
13. 13. Kurtul A, Murat SN, Yarlioglues M et al. Association of plateletto-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndromes. Am J Cardiol 2014; 114: 972-8.
14. 14. Kurtul S, Sarli B, Baktir AO et al. Neutrophil to lymphocyte ratio predicts SYNTAX score in patients with non-ST segment elevation myocardial infarction. Int Heart J. 2015; 56: 18-21.
15. 15. Kundi H, Kiziltunc E, Cetin M et al. Association of monocyte/ HDL-C ratio with SYNTAX scores in patients with stable coronary artery disease. Herz 2016; 41: 523-9.
16. 16. Hartwig H, Silvestre Roig C, Daemen M, Lutgens E, Soehnlein O. Neutrophils in atherosclerosis. A brief overview. Hamostaseologie 2015; 35: 121-7.
17. 17. Huang JB, Chen YS, Ji HY et al. Neutrophil to high-density lipoprotein ratio has a superior prognostic value in elderly patients with acute myocardial infarction: a comparison study. Lipids Health Dis 2020; 19: 59.
18. 18. Curcic S, Holzer M, Frei R et al. Neutrophil effector responses are suppressed by secretory phospholipase A2 modified HDL. Biochim Biophys Acta 2015; 1851: 184-93.
19. 19. Cogny A, Atger V, Paul JL, Soni T, Moatti N. High-density lipoprotein 3 physicochemical modifications induced by interaction with human polymorphonuclear leucocytes affect their ability to remove cholesterol from cells. Biochem J 1996; 314: 285-92.
20. 20. Man JJ, Beckman JA, Jaffe IZ. Sex as a Biological Variable in Atherosclerosis. Circ Res 2020; 126: 1297-319.