Abstract
We read with interest the recent authoritative review article by Apple et al. (1) regarding biomarkers and acute coronary syndromes (ACS). Although the article is both exhaustive and clinically relevant, we felt that the authors failed to recognize the potential value of neopterin as a marker of cardiovascular risk. Neopterin, a pteridine derivative produced by activated macrophages in response to stimulation by interferon-γ, is a marker of both immune activation and coronary artery disease (CAD) activity (2). Several studies have shown that circulating neopterin concentrations are higher in patients with ACS than in patients with chronic stable angina pectoris (CSA) and in apparently healthy persons. Increased neopterin is associated with the presence of vulnerable or disrupted atheromatous plaques (3) and represents a marker of increased risk of further events in patients with ACS (4). Moreover, recent studies …
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