Rubattu Speranza, De Giusti Marco, Farcomeni Alessio, Abbolito Sofia, Comito Filomena, Cangianiello Sara, Greco Ettore S, Dito Eleonora, Pagliaro Beniamino, Cotugno Maria, Stanzione Rosita, Marchitti Simona, Bianchi Franca, Di Castro Sara, Battistoni Allegra, Burocchi Simone, Caprinozzi Massimo, Pierelli Giorgia, Sciarretta Sebastiano, Volpe Massimo
aIRCCS Neuromed, Pozzilli bDept. of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Ospedale S. Andrea, Rome cDept. of Science of Public Health and Infectious Diseases, School of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy.
J Cardiovasc Med (Hagerstown). 2016 Aug;17(8):601-7. doi: 10.2459/JCM.0000000000000195.
The role of C2238/atrial natriuretic peptide (ANP) minor allele, at the T2238C ANP gene variant, as a predisposing risk factor for acute cardiovascular events, has been previously reported. We aimed at evaluating, by a retrospective approach, the long-term impact of C2238/ANP-minor allele carrier status toward the risk of recurrent acute coronary syndromes (re-ACS) in an Italian cohort of ischemic heart disease patients.
A total of 379 patients (males = 80.5%; mean age = 62.5 ± 9.2 years) presenting with ACS were retrospectively analyzed. Mean follow-up was 5.1 ± 3.5 years (range 1-26 years). Occurrence of new episodes of unstable angina, non-ST-segment elevation myocardial infarction and STE myocardial infarction over the years was recorded and compared between subjects not carrying and carrying C2238/ANP-minor allele.
At univariate analysis, C2238/ANP-minor allele carrier status and treatment with beta-blocker, aspirin and statin were associated with risk of re-ACS. Multivariate analysis confirmed that hypercholesterolemia (P < 0.0001) and C2238/ANP-minor allele carrier status (P < 0.05) were both significantly and independently associated with increased risk of re-ACS. Both treatments with beta-blocker and with statin were significantly associated with reduced risk of re-ACS (P = 0.01 and P < 0.01, respectively). Age above 55 years was associated with recurrence of ACS in C2238/ANP-minor allele carriers (hazard ratio 1.427, 95% confidence interval 1.066-1.911, P = 0.017). Kaplan-Meier curves confirmed highest risk of new events occurrence in C2238/ANP-minor allele carriers (P = 0.035).
The present results demonstrate that C2238/ANP-minor allele carrier status is an independent risk factor for ACS recurrence in an Italian cohort of ischemic heart disease patients over the long term, and they support the role of C2238/ANP-minor allele as a negative prognostic factor in coronary artery disease patients.
先前已有报道，T2238C型心房利钠肽（ANP）基因变异中的C2238/ANP次要等位基因作为急性心血管事件的易感风险因素所起的作用。我们旨在通过回顾性研究方法，评估在意大利一组缺血性心脏病患者中，C2238/ANP次要等位基因携带者状态对复发性急性冠状动脉综合征（再发性急性冠状动脉综合征，re-ACS）风险的长期影响。
对总共379例出现急性冠状动脉综合征（ACS）的患者（男性占80.5%；平均年龄62.5±9.2岁）进行回顾性分析。平均随访时间为5.1±3.5年（范围1 - 26年）。记录并比较未携带和携带C2238/ANP次要等位基因的受试者多年来不稳定型心绞痛、非ST段抬高型心肌梗死和ST段抬高型心肌梗死新发作的情况。
在单因素分析中，C2238/ANP次要等位基因携带者状态以及使用β受体阻滞剂、阿司匹林和他汀类药物治疗与再发性急性冠状动脉综合征的风险相关。多因素分析证实，高胆固醇血症（P<0.0001）和C2238/ANP次要等位基因携带者状态（P<0.05）均与再发性急性冠状动脉综合征风险增加显著且独立相关。使用β受体阻滞剂和他汀类药物治疗均与再发性急性冠状动脉综合征风险降低显著相关（分别为P = 0.01和P<0.01）。55岁以上年龄与C2238/ANP次要等位基因携带者的急性冠状动脉综合征复发相关（风险比1.427，95%置信区间1.066 - 1.911，P = 0.017）。Kaplan-Meier曲线证实C2238/ANP次要等位基因携带者发生新事件的风险最高（P = 0.035）。
目前的结果表明，在意大利一组缺血性心脏病患者中，C2238/ANP次要等位基因携带者状态是急性冠状动脉综合征复发的独立风险因素，并且支持C2238/ANP次要等位基因作为冠状动脉疾病患者不良预后因素的作用。
