Abstract
BackgroundInterleukin-6 (IL-6) plays a central role in atherosclerosis and inflammation. It may improve risk prediction in patients at intermediate cardiovascular risk.ObjectiveTo analyze the impact of serum IL-6 in predicting early angiographic coronary artery disease in patients at intermediate cardiovascular risk with chest pain.MethodsIn a cross-sectional study, patients referred for coronary angiography due to suspected coronary artery disease (CAD) were included. Coronary artery disease was defined as the presence of at least 30% stenosis in one or more coronary artery. Severity of CAD was classified by the anatomic burden score. Performance of serum IL-6 assay was compared with ACC/AHA atherosclerotic cardiovascular disease (ASCVD) risk score and hs-CRP through receiver operating characteristic (ROC) curves.ResultsWe have included 48 patients with a mean 10-year ASCVD risk of 10.0 ± 6.8%. The prevalence of CAD was 72.9%. The presence of CAD was associated with higher mean levels of IL-6 (p = 0.025). Patients with CAD had significantly more overweight than subjects without CAD. In 27% of patients, IL-6 was >1.0 pg/mL and 100% of these patients had CAD, while only 64% in those with IL-6 <1.0 pg/mL, corresponding to a positive predictive value of 100% (p = 0.015). The area under the receiver operating characteristic (ROC) curve of IL-6, hs-CRP and ASCVD were respectively 0.72, 0.60 and 0.54. Intermediate risk patients with IL-6 >1.0 pg/mL were further reclassified into ASCVD high risk due to the presence of coronary lesions.ConclusionIn intermediate risk patients referred for coronary angiography, a serum IL-6 level above 1 pg/mL is predictive of significant CAD. IL-6 determination may be useful to reclassify ASCVD intermediate risk patients into higher risk categories.
Highlights
Interleukin-6 (IL-6) plays a central role in atherosclerosis and inflammation
In intermediate risk patients referred for coronary angiography, a serum IL-6 level above 1 pg/mL is predictive of significant Coronary artery disease (CAD)
Study design and patients We have conducted a prospective cross-sectional study with patients referred for coronary angiography due to non-acute chest pain in a reference cardiology center at Hospital de Clínicas of Porto Alegre, Brazil
Summary
Interleukin-6 (IL-6) plays a central role in atherosclerosis and inflammation It may improve risk prediction in patients at intermediate cardiovascular risk. 10 year ASCVD risk score to estimate the risk for future coronary events and to define strategies of primary prevention [4]. This approach is important, the precision in patients at intermediate coronary risk is less accurate than in higher or lower risk categories [5]. Middle-aged non-diabetic individuals who have few cardiovascular risk factors are considered at intermediate-high risk, and the presence of chest pain in these patients poses an important challenge for the health care team. The use of emergent biomarkers may help in risk reclassification, being an interesting approach
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