The impact of selectins on mortality in stable carotid atherosclerosis

Matthias Hoke; Max-Paul Winter; Oswald Wagner; Markus Exner; Martin Schillinger; Zsuzsanna Arnold; Wolfgang Mlekusch; Gerald Maurer; Renate Koppensteiner; Erich Minar; Georg Goliasch

doi:10.1160/TH14-12-1014

Thrombosis and Haemostasis, Table of Contents

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

¹Division of Angiology, Department of Internal Medicine II, Medical University, Vienna, Austria

,

Max-Paul Winter

²Division of Cardiology, Department of Internal Medicine II, Medical University, Vienna, Austria

,

Oswald Wagner

³Department of Laboratory Medicine, Medical University, Vienna, Austria

,

Markus Exner

³Department of Laboratory Medicine, Medical University, Vienna, Austria

,

Martin Schillinger

¹Division of Angiology, Department of Internal Medicine II, Medical University, Vienna, Austria

,

Zsuzsanna Arnold

¹Division of Angiology, Department of Internal Medicine II, Medical University, Vienna, Austria

,

Wolfgang Mlekusch

¹Division of Angiology, Department of Internal Medicine II, Medical University, Vienna, Austria

,

Gerald Maurer

²Division of Cardiology, Department of Internal Medicine II, Medical University, Vienna, Austria

,

Renate Koppensteiner

¹Division of Angiology, Department of Internal Medicine II, Medical University, Vienna, Austria

,

Erich Minar

¹Division of Angiology, Department of Internal Medicine II, Medical University, Vienna, Austria

,

Georg Goliasch

²Division of Cardiology, Department of Internal Medicine II, Medical University, Vienna, Austria

› Author Affiliations

Abstract

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

Full Text

References

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