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Thromb Haemost 2015; 114(03): 632-638
DOI: 10.1160/TH14-12-1014
Atherosclerosis and Ischaemic Disease
Schattauer GmbH

The impact of selectins on mortality in stable carotid atherosclerosis

Matthias Hoke
1   Division of Angiology, Department of Internal Medicine II, Medical University, Vienna, Austria
,
Max-Paul Winter
2   Division of Cardiology, Department of Internal Medicine II, Medical University, Vienna, Austria
,
Oswald Wagner
3   Department of Laboratory Medicine, Medical University, Vienna, Austria
,
Markus Exner
3   Department of Laboratory Medicine, Medical University, Vienna, Austria
,
Martin Schillinger
1   Division of Angiology, Department of Internal Medicine II, Medical University, Vienna, Austria
,
Zsuzsanna Arnold
1   Division of Angiology, Department of Internal Medicine II, Medical University, Vienna, Austria
,
Wolfgang Mlekusch
1   Division of Angiology, Department of Internal Medicine II, Medical University, Vienna, Austria
,
Gerald Maurer
2   Division of Cardiology, Department of Internal Medicine II, Medical University, Vienna, Austria
,
Renate Koppensteiner
1   Division of Angiology, Department of Internal Medicine II, Medical University, Vienna, Austria
,
Erich Minar
1   Division of Angiology, Department of Internal Medicine II, Medical University, Vienna, Austria
,
Georg Goliasch
2   Division of Cardiology, Department of Internal Medicine II, Medical University, Vienna, Austria
› Author Affiliations
Further Information

Publication History

Received: 06 December 2014

Accepted after major revision: 10 April 2015

Publication Date:
01 December 2017 (online)

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Summary

Cellular adhesion molecules also known as selectins promote recruitment of inflammatory cells into the arterial wall where they interact with lipid particles leading subsequently to plaque formation. The intercellular adhesion molecule-1 (ICAM-1), the vascular cell adhesion molecule-1 (VCAM-1) and the endothelial-leukocyte adhesion molecule 1 (ELAM-1) also known as E-selectin mediate the attachment of leukocytes and have been implicated in the destabilisation of atherosclerotic plaques. Therefore, we hypothesised that plasma selectin levels are associated with adverse clinical outcome. We prospectively studied 855 patients with sonographically confirmed carotid atherosclerosis. During a median follow-up of 6.2 years, corresponding to 5,551 overall person-years, 275 patients (26 %) died. We detected a significant association between cardiovascular mortality and ICAM-1 (adjusted hazard ratio [HR]: 3.43, 95 % confidence interval [CI] 2.00–5.88, p< 0.001) as well as VCAM-1 (adjusted HR: 2.51, 95 % CI 1.45–4.34, p=0.001) when comparing the fourth with the first quartile. Comparable results were obtained for all-cause mortality. In contrast, we could not detect a significant association between E-selectin and all-cause or cardiovascular mortality. We identified the selectins ICAM-1 and VCAM-1 as strong and independent predictors of all-cause and cardiovascular mortality in patients with stable carotid atherosclerosis. These molecules are elevated in states of endothelial activation and might assist to monitor anti-atherosclerotic therapy and select those patients with carotid atherosclerosis, who are at higher risk for cardiovascular events.

Keywords

Cell adhesion molecules - carotid atherosclerosis - risk prediction
 

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