Evaluation of serum neopterin, high-sensitivity C-reactive protein and thiobarbituric acid reactive substances in Egyptian patients with acute coronary syndromes

Abstract

The present study evaluated serum neopterin, high-sensitivity C-reactive protein (hs-CRP) and thiobarbituric acid reactive substances (TBARS) in Egyptian patients with acute coronary artery disease. Thirty-six patients with unstable angina aged (mean +/- SD) 61.3+/-9.4 years, 29 patients with myocardial infarction aged 58.2+/-8.7 years and 24 sex- and age-matched control subjects were included in the study. Neopterin levels were significantly higher in patients with myocardial infarction and those with unstable angina than in the healthy control group (P<0.001). The serum level of neopterin in the control group (median [range]) was 3.25 nmol/L (1.25 nmol/L to 5.4 nmol/L), whereas in patients with unstable angina and those with myocardial infarction, neopterin levels were 10.4 nmol/L (3.5 nmol/L to 15.2 nmol/L) and 12.6 nmol/L (3.25 nmol/L to 17.8 nmol/L), respectively. Levels of hs-CRP and TBARS were also significantly higher in patients with unstable angina and those with myocardial infarction than in the healthy control group (P<0.01). The medians (ranges) of hs-CRP were 4.8 mg/L (2.5 mg/L to 9.9 mg/L), 12.0 mg/L (4.6 mg/L to 31.0 mg/L) and 12.3 mg/L (7.5 mg/L to 32.1 mg/L) in the control group, patients with unstable angina and those with myocardial infarction, respectively. The means +/- SD of TBARS in the control group, patients with unstable angina and those with myocardial infarction were 0.64+/-0.17 mumol/L, 1.17+/-0.31 mumol/L and 1.17+/-0.49 mumol/L, respectively. TBARS positively correlated with hs-CRP and neopterin levels. Furthermore, when both patients and controls were classified according to their smoking status, significantly higher levels of neopterin and TBARS were found in the smokers of each subgroup than in the nonsmokers.In conclusion, the present study found a higher level of neopterin, hs-CRP and TBARS in patients with coronary artery disease. Serum neopterin and hs-CRP positively correlated with the level of TBARS. The authors suggest that triggering factors (eg, smoking, high cholesterol, elevated body mass index or raised blood pressure) may lead to increased oxidative stress, which induces an inflammatory insult leading to higher levels of inflammatory markers such as neopterin and hs-CRP.

Keywords: CAD; Neopterin; Oxidative stress; TBARS; hs-CRP.

Figures

Figure 1)

Box plots illustrating plasma neopterin (nmol/L) in healthy controls, in patients with unstable angina (UA) and in patients with myocardial infarction (MI). The box plots represent the interquartile range from the 25th to the 75th percentile, which contains 50% of the values. The whiskers below and above the boxes represent the minimum and maximum values, respectively. The line across the boxes represents the median value. **Significant difference at P

Figure 2)

Plasma high-sensitivity C-reactive protein (CRP) and thiobarbituric acid reactive substances (TBARS) in the studied groups. A Box plots illustrating the serum level of high-sensitivity CRP in the control group, in patients with unstable angina (UA) and in patients with myocardial infarction (MI). Box plots are formatted as in Figure 1. B Bar graph illustrating the means ± SD of TBARS in the control group, in patients with UA and in patients with MI. The mean value of TBARS (μmol/L) is shown at the top of the bar for each group. **Significant difference at P<0.01 versus controls; •High outliers (values larger than the upper quartile plus 1.5 times the interquartile range)

Figure 3)

Effect of smoking on neopterin and thiobarbituric acid reactive substances (TBARS) in the studied groups. A Box plots illustrating the level of neopterin (nmol/L) in the control group, patients with unstable angina (UA) and patients with myocardial infarction (MI) after stratification according to history of smoking. Box plots are formatted as in Figure 1. B Bar graph illustrating the means ± SD of serum TBARS (μmol/L) in the control group, patients with UA and patients with MI after stratification according to history of smoking. The mean value of TBARS is shown at the top of each bar. *Significantly different at P<0.05 versus controls; **Significantly different at P<0.01 versus controls; •Low outliers (values smaller than the lower quartile plus 1.5 times the interquartile range); ♦Extreme values (values larger than the upper quartile plus three times the interquartile range)