Increased serum neopterin: a marker of coronary artery disease activity in women 2000;83: 346-50

Levels of a chemical produced by the immune system may be able to predict worsening symptoms of coronary artery disease in women, finds a study in Heart.

Researchers studied over 100 women with angina. Around two thirds of them had chronic stable angina, defined by characteristic pain on exertion or after exercise, and the remainder had unstable angina-the same symptoms, but occurring unpredictably and mainly at rest, and associated with worsening of the condition.

Their heart function, symptoms of chest pain as well as the number of acute events, such as heart attack, were monitored over a period of 12 months. Levels of a substance called neopterin were also measured. This is released when the immune system is activated and is also detectable in patients with cancer and viral infections.

Twice as many women with unstable angina sustained major clinical events, and their levels of neopterin were significantly higher than in women with stable angina. Among the women with stable angina who sustained an acute worsening of their condition, neopterin levels were also significantly higher than among those whose condition remained the same. Levels of the substance were also similar in the women with unstable angina and those with stable angina but with acute exacerbations of their condition.

Long term activation of immune cells may have a role in the build-up of fatty deposits (plaques) in the arteries, or in the response to other stimuli, or both, conclude the authors.They suggest that presence of high neopterin levels may indicate that the disease is worsening rather than merely the extent of the disease itself.

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BMJ-British Medical Journal
23-Feb-2000