Biomarkers of Inflammation and Oxidative stress in the Prediction and Management of Acute Coronary Syndrome

Udaya Ralapanawa,Sivakanesan R

doi:10.15342/hs.3.595

Abstract

The assessment of patients presenting with chest pain or symptoms indicative of cardiac ischemia remains a diagnostic challenge. Many types of research have focused on the search for ideal biological markers for the rapid detection of cardiac cell injuries. Markers of inflammation and oxidative stress are the way forward. At present, the biomarker most widely used for diagnosing acute coronary syndrome is cardiac troponin though it has some limitations. Apart from cardiac troponin, several other biomarkers, especially inflammation and oxidative stress markers in acute coronary syndrome, have been investigated. However, most of them still require validation in further studies. As markers of inflammation and oxidative stress address a particular aspect of the pathophysiology of acute coronary syndrome, these biomarkers may provide unique information to the managing clinician separate from that of markers of myocyte necrosis. Serum markers of inflammation and oxidative stress appear before cardiac necrosis markers and are valuable targets for early and timely diagnosis of an acute cardiac event. Using these markers in combination with biomarkers of plaque formation, unstable plaque development, plaque rupture, thrombosis, and myocardial necrosis (multimarker approach) could increase their diagnostic and prognostic value.

Highlights

Cardiovascular disease is the worldwide leading cause of mortality and morbidity
Limitations with cardiac troponins cTn elevation persists for days, initial detection is deferred after myocardial injury, as necrosis naturally necessitates 2-4 hours to occur following ischemia
Inflammation plays a vital role in atherosclerosis, and analysis of inflammatory markers like high sensitive Creactive protein will offer a novel means for exposing individuals to a high chance of plaque rupture [23].Standard clinical assay for CRP processes a lower detection limit of 3 to 8mg/dL, cannot be used effectively for vascular risk prediction

Summary

Introduction

Cardiovascular disease is the worldwide leading cause of mortality and morbidity. The 2011 annual report from World Health Organization(WHO) highlighted the mortality rate prediction of the population worldwide that, in 2030, cardiovascular disease will become the leading cause of death, and mortality rate will be higher than infectious diseases such as HIV, Tuberculosis, malaria infection [1]. The severity of coronary artery obstruction and the volume of affected myocardium determined clinical presentation characteristics. Patients with total occlusion may present with ST-segment elevation infarction if the lesion occludes an artery supplying a substantial volume of the myocardium. Incomplete occlusion at the site of a disrupted arterial plaque could create ischemia or micro infarction depending on the size of the myocardium affected [2, 3]

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