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European Heart Journal 2003 24(22):2006-2011; doi:10.1016/j.ehj.2003.09.029
Copyright © 2003 by the European Society of Cardiology.
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Clinical research

Chronic inflammation and increased arterial stiffness in patients with cardiac syndrome X

Ramón Arroyo-Espliguero1, Nadia Mollichelli1, Pablo Avanzas, Emmanouil Zouridakis, Valentine R Newey, Dariush K Nassiri and Juan Carlos Kaski*

Coronary Artery Disease Research Unit, Department of Cardiovascular Sciences, St. George's Hospital Medical School, London, UK

* Correspondence to: Professor Juan Carlos Kaski, Head, Cardiological Sciences, St. George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK. Tel: +44 20 8725 3963; fax: +44 20 8725 3328
E-mail address: jkaski{at}sghms.ac.uk

Received 21 April 2003; revised 17 September 2003; accepted 25 September 2003

Abstract

Aims Endothelial dysfunction and subangiographic atheroma have been reported in patients with cardiac syndrome X (CSX) but little is known regarding chronic inflammation and reduced arterial distensibility as pathogenic mechanisms. We assessed whether markers of inflammation and arterial distensibility differ in CSX patients compared to control subjects.

Methods and results We studied 30 consecutive CSX patients (mean age 57±6 years, 25 women) and 30 healthy controls (mean age 54±8 years, 25 women). High sensitivity C-reactive protein (hs-CRP) levels were significantly higher in patients with CSX compared to controls (2.6 [1.7–4.5] vs 1.5[0.7–2.7] mg/l, P=0.02). Hs-CRP levels correlated with carotid intima-media thickness (IMT) (Spearman's rho=0.51; P=0.013). CSX patients also had significantly increased mean IMT values than controls (P<0.0001). Arterial stiffness and elastic modulus were also significantly increased in CSX patients compared to control subjects (P=0.04 and P=0.04, respectively). Distensibility tended to be lower in CSX patients than controls although this difference did not reach statistical significance.

Conclusions This study showed for the first time that compared to control subjects, patients with CSX have higher hs-CRP serum levels, increased mean common carotid artery IMT and increased arterial stiffness. The role of these abnormalities in the pathogenesis of CSX deserves investigation.

Key Words: Cardiac syndrome X • Inflammation • C-reactive protein • Intima-media thickness • Arterial distensibility


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