Long-Term Prognostic Value of Neopterin
- 19 June 2007
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 115 (24), 3071-3078
- https://doi.org/10.1161/circulationaha.106.666511
Abstract
Background— Monocyte activation is believed to play an important role in the pathogenesis of acute coronary syndromes (ACS). Neopterin is a soluble marker of monocyte activation, and elevated levels are of prognostic value in patients with stable coronary artery disease. Methods and Results— Neopterin levels were measured on average at 7 days (in 3946 patients) and at 4 months (in 3369 patients) after ACS in the PRavastatin Or atorVastatin Evaluation Infection Therapy–Thrombolysis In Myocardial Infarction (PROVE IT–TIMI 22) trial. We assessed the relationship between plasma neopterin levels and the risk of death and death or acute coronary events (nonfatal myocardial infarction or unstable angina) over 2 years. Seven days after an ACS event, neopterin levels ≥12.11 nmol/L (upper quartile, derived from a post hoc analysis) were associated with an increased risk of death and an increased risk of death or acute coronary events after adjustment for age, gender, history of diabetes mellitus, history of hypertension, history of smoking, type of ACS presentation, use of percutaneous coronary intervention for the index event, statin regimen, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein (hazard ratio, 1.86 [95% CI, 1.24 to 2.77], P =0.003; and hazard ratio, 1.33 [95% CI, 1.09 to 1.63] P =0.006, respectively). Neopterin levels ≥12.11 nmol/L at 4 months remained a predictor of death alone and of death or acute coronary events after multivariable adjustment that included adjustment for month 4 low-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and statin regimen (hazard ratio, 2.39 [95% CI, 1.43 to 3.99], P =0.001; and hazard ratio, 1.60 [95% CI, 1.21 to 2.11], P =0.001). High-dose atorvastatin significantly attenuated the risk among subjects with neopterin levels ≥12.11 nmol/L at baseline (interaction P for death or acute coronary event, 0.018). Conclusions— Increased monocyte activation detected by an elevated plasma neopterin level identifies patients at long-term risk of death or recurrent acute coronary events after ACS. Intensive statin therapy significantly attenuates the risk of recurrent events among patients with an elevated neopterin level.Keywords
This publication has 34 references indexed in Scilit:
- Clinical Relevance of C-Reactive Protein During Follow-Up of Patients With Acute Coronary Syndromes in the Aggrastat-to-Zocor TrialCirculation, 2006
- Serum neopterin levels in patients with brucellosisJournal of Infection, 2005
- Relationship Between Uncontrolled Risk Factors and C-Reactive Protein Levels in Patients Receiving Standard or Intensive Statin Therapy for Acute Coronary Syndromes in the PROVE IT-TIMI 22 TrialJournal of the American College of Cardiology, 2005
- Inflammation, Atherosclerosis, and Coronary Artery DiseaseNew England Journal of Medicine, 2005
- Serum Neopterin, an Immune Activation Marker, Independently Predicts Disease Progression in Advanced HIV-1 InfectionClinical Infectious Diseases, 2005
- Elevated serum neopterin predicts future adverse cardiac events in patients with chronic stable angina pectorisEuropean Heart Journal, 2005
- Markers of inflammation and multiple complex stenoses (pancoronary plaque vulnerability) in patients with non-ST segment elevation acute coronary syndromesHeart, 2004
- Serum Level of the Antiinflammatory Cytokine Interleukin-10 Is an Important Prognostic Determinant in Patients With Acute Coronary SyndromesCirculation, 2003
- Human Parvovirus B19 Detection in Asymptomatic Blood Donors: Association with Increased Neopterin ConcentrationsThe Journal of Infectious Diseases, 2002
- Urinary Neopterin Index as a Measure of Rheumatoid ActivityScandinavian Journal of Rheumatology, 1986