Differential profile in inflammatory and mineral metabolism biomarkers in patients with ischemic heart disease without classical coronary risk factors

Abstract

BACKGROUND Patients with coronary heart disease (CHD) without classical cardiovascular risk factors (CRF) are uncommon, and their profile has not been thoroughly studied. In CHD patients, we have assessed the differences in several biomarkers between those with and without CRF. METHODS We studied 704 patients with CHD, analyzing plasma levels of biomarkers related to inflammation, thrombosis, renal damage, and heart failure: hs-CRP (high-sensitivity C-reactive protein), MCP-1 (monocyte chemoattractant protein-1), galectin-3, NT-pro-BNP (N-terminal fragment of brain natriuretic peptide), calcidiol (vitamin D metabolite), fibroblast growth factor-23 (FGF-23), parathormone, and phosphate. RESULTS Twenty patients (2.8%) exhibited no CRFs. Clinical variables were well balanced in both groups, with the logical exceptions of no use of antidiabetic drugs, lower triglyceride and glucose, and higher high-density lipoprotein cholesterol in no-CRF patients. No-CRF patients showed lower hs-CRP (2.574±3.120 vs 4.554±9.786 mg/L; P=0.018), MCP-1 (114.75±36.29 vs 143.56±65.37 pg/ml; P=0.003) and FGF-23 (79.28±40.22 vs 105.17±156.61 RU/ml; P=0.024) and higher calcidiol (23.66±9.12 vs 19.49±8.18 ng/ml; P=0.025) levels. At follow-up, 10.0% vs 11.0% patients experienced acute ischemic event, heart failure, or death in the non-CRF and CRF groups, respectively (P=0.815, log-rank test). The limited number of non-CRF patients may have influenced this finding. A Cox regression analysis in the whole population showed that high calcidiol, and low MCP-1 and FGF-23 plasma levels are associated to a better prognosis. CONCLUSIONS CHD patients without CRFs show a favorable biomarker profile in terms of inflammation and mineral metabolism. Further studies are needed to investigate whether this difference translates into a better prognosis.