Neopterin and Cardiovascular Disease: Growing Evidence for a Role in Patient Risk Stratification

Abstract

Compelling evidence has emerged in recent years regarding the implications of inflammation in the pathogenesis of atherosclerosis and its complications (1). The growing appreciation of the role of inflammation in atherogenesis, atheromatous plaque growth, and plaque disruption has triggered interest as to whether circulating inflammatory biomarkers may help to identify subjects at risk of future cardiovascular events. Of all currently available biomarkers, high-sensitivity C-reactive protein (hsCRP)1 appears to have the best profile as an independent predictor of increased coronary risk (2). Despite being a nonspecific acute-phase reactant, hsCRP has been shown in large epidemiological and clinical studies to be an independent predictor of cardiovascular events (3), i.e., myocardial infarction, stroke, and death in patients with angina (4) and apparently healthy subjects. Because hsCRP is not a specific marker of vascular inflammation, however, the search for highly sensitive and specific markers of risk continues unabated. Evidence from our group (5)(6)(7)(8) and others (9)(10) in recent years indicates that neopterin, an immune modulator produced by activated macrophages, may be useful for cardiovascular risk stratification in patients with coronary artery disease. In this issue of Clinical Chemistry , Grammer et al. (11 …