Blankenberg S, Rupprecht H J, Bickel C, Peetz D, Hafner G, Tiret L, Meyer J
Department of Medicine II, Johannes Gutenberg-University Mainz, Germany.
Circulation. 2001 Sep 18;104(12):1336-42. doi: 10.1161/hc3701.095949.
Vascular cell adhesion molecule (VCAM)-1, intercellular adhesion molecule (ICAM)-1, and E-selectin mediate adhesion and transmigration of leukocytes to the vascular endothelial wall and may promote plaque growth and instability. In a prospective study, we evaluated the effect of soluble adhesion molecules on the risk of future cardiovascular events among patients with angiographically documented coronary artery disease (CAD). Methods and Results- -We obtained baseline samples from a prospective cohort of 1246 patients with CAD. Besides various markers of inflammation, soluble VCAM-1 (sVCAM-1), sICAM-1, and sE-selectin were determined. Follow-up information on cardiovascular events was obtained (mean, 2.7; maximum, 4.1 years). Independently higher levels of sVCAM-1 (1932 versus 1128 ng/mL; P<0.0001), sICAM-1 (353 versus 287 ng/mL; P=0.015), and sE-selectin (81 versus 63 ng/mL; P=0.003) were observed in patients with future death from cardiovascular causes. In a multivariate model, fatal risk was 2.1-fold (1.1 to 4.0) higher in patients within the top quartile of baseline sVCAM-1 concentrations compared with lower quartiles. This association was present independent of general inflammatory response as reflected by low or high C-reactive protein (hs-CRP) levels. In a model that simultaneously controlled for all inflammatory and soluble adhesion markers determined, only sVCAM-1 remained independently significant for future fatal cardiovascular events, with a 2.8-fold increase in risk (P=0.003).
Soluble adhesion molecules sVCAM-1, sICAM-1, and sE-selectin were significantly related to future death from cardiovascular causes among patients with documented CAD. Especially sVCAM-1 added to the predictive value of classic risk factors and hs-CRP in determining the risk of future cardiovascular death.
血管细胞黏附分子（VCAM）-1、细胞间黏附分子（ICAM）-1和E-选择素介导白细胞与血管内皮壁的黏附与迁移，并可能促进斑块生长和不稳定。在一项前瞻性研究中，我们评估了可溶性黏附分子对血管造影证实的冠心病（CAD）患者未来发生心血管事件风险的影响。
我们从1246例CAD患者的前瞻性队列中获取基线样本。除了各种炎症标志物外，还测定了可溶性VCAM-1（sVCAM-1）、sICAM-1和sE-选择素。获得了心血管事件的随访信息（平均2.7年；最长4.1年）。在未来因心血管原因死亡的患者中，观察到sVCAM-1（1932对1128 ng/mL；P<0.0001）、sICAM-1（353对287 ng/mL；P=0.015）和sE-选择素（81对63 ng/mL；P=0.003）水平独立升高。在多变量模型中，与较低四分位数相比，基线sVCAM-1浓度处于最高四分位数的患者的死亡风险高2.1倍（1.1至4.0）。这种关联独立于由高或低C反应蛋白（hs-CRP）水平反映的一般炎症反应。在同时控制所有测定的炎症和可溶性黏附标志物的模型中，只有sVCAM-1对未来致命性心血管事件仍具有独立显著性，风险增加2.8倍（P=0.003）。
可溶性黏附分子sVCAM-1、sICAM-1和sE-选择素与已确诊CAD患者未来因心血管原因死亡显著相关。尤其是sVCAM-1增加了经典危险因素和hs-CRP在确定未来心血管死亡风险方面的预测价值。
