Abstract
BackgroundVirtual Histology Intravascular Ultrasound (VH–IVUS) may be used to detect early signs of unstable coronary artery disease. Monocyte Chemoattractant Protein-1 (MCP-1) is linked with coronary atherosclerosis and plaque instability and could potentially be modified by folic acid treatment.MethodsIn a randomized, prospective study, 102 patients with stable angina pectoris (SAP) received percutaneous coronary intervention and established medical treatment as well as either homocysteine-lowering folic acid/vitamin B12 (±B6) or placebo (±B6) for 1 year before VH–IVUS was performed. The presence of VH-Thin-Cap Fibroatheroma (VH-TCFA) in non-intervened coronary vessels was registered and serum levels of MCP-1 were measured. The patients were subsequently followed for incident myocardial infarction (MI).ResultsPatients treated with folic acid/vitamin B12 had a geometric mean (SD) MCP-1 level of 79.95 (1.49) versus 86.00 (1.43) pg/mL for patients receiving placebo (p-value 0.34). VH-TCFA lesions were present in 7.8% of patients and did not differ between intervention arms (p-value 0.47). Serum levels of MCP-1 were 1.46 (95% CI 1.12 to 1.92) times higher in patients with VH-TCFA lesions than in those without (p-value 0.005). Afterwards, patients were followed for median 2.1 years and 3.8% experienced a myocardial infarction (MI), which in post-hoc Cox regression analyses was independently predicted by both MCP-1 (P-value 0.006) and VH-TCFA (p-value 0.01).ConclusionsIn patients with SAP receiving established medical treatment, folic acid supplementation is not associated with either presence of VH-TCFA or levels of MCP-1. MCP-1 is however associated with VH-TCFA, a finding corroborated by increased risk for future MI. ClinicalTrials.gov Identifier: NCT00354081.
Highlights
While significant progress has been made in both diagnosis and treatment of coronary artery disease (CAD), a substantial number of patients still experience recurrent coronary events [1]
Statins were used by 98% of the population, while acetylsalicylic acid was taken by 94%
Regarding clinical and biochemical characteristics, only apolipoprotein A1 differed statistically significant between the thin cap fibrous atheroma (TCFA) and nonTCFA group (p-value 0.05) when not adjusted for multiple comparisons
Summary
While significant progress has been made in both diagnosis and treatment of coronary artery disease (CAD), a substantial number of patients still experience recurrent coronary events [1]. Common underlying features of these events are non-flowlimiting, angiographically non-significant stenosis – culprit lesions with an unstable atherosclerotic plaque phenotype. These lesions are characterized by: a thin cap fibrous atheroma (TCFA) overlying a necrotic core with an extensive inflammatory infiltrate, a plaque erosion or a calcified nodule [2,3,4]. Virtual Histology Intravascular Ultrasound (VH–IVUS) may be used to detect early signs of unstable coronary artery disease. Monocyte Chemoattractant Protein-1 (MCP-1) is linked with coronary atherosclerosis and plaque instability and could potentially be modified by folic acid treatment
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