CLINICAL RESEARCH: CAROTID AND PERIPHERAL ATHEROSCLEROSIS
Myeloperoxidase Predicts Progression of Carotid Stenosis in States of Low High-Density Lipoprotein Cholesterol
Markus Exner, MD*,
Erich Minar, MD ,
Wolfgang Mlekusch, MD,
Schila Sabeti, MD,
Jasmin Amighi, MD,
Wolfgang Lalouschek, MD ,
Gerald Maurer, MD ,
Christian Bieglmayer, PhD*,
Heidi Kieweg*,
Oswald Wagner, MD* and
Martin Schillinger, MD,*
* Medical and Chemical Laboratory Diagnostics
Angiology
Neurology
Cardiology, Medical University Vienna, Vienna, Austria
Manuscript received November 7, 2005;
revised manuscript received January 11, 2006,
accepted January 16, 2006.
* Reprint requests and correspondence: Dr. Martin Schillinger, Division of Angiology, Department of Internal Medicine II, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria (Email: martin.schillinger{at}meduniwien.ac.at).
OBJECTIVES: We investigated the effect of myeloperoxidase (MPO) on progression of carotid stenosis in states of high and low high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C) levels.
BACKGROUND: Myeloperoxidase is pivotally involved in the pathogenesis of atherosclerosis. In vitro data suggest that MPO exerts deleterious effects via oxidative modulation of lipoproteins.
METHODS: We prospectively studied 1,019 of 1,268 consecutive patients who were asymptomatic with respect to carotid artery disease. Patients underwent serial carotid ultrasound investigations at baseline and after a follow-up interval of median 7.5 months (range 6 to 9 months), categorizing carotid arteries as 0% to 29%, 30% to 49%, 50% to 69%, 70% to 89%, or 90% to 99% stenosed or occluded. The MPO, HDL-C, and LDL-C levels were measured at baseline, grouped by medians, and correlated with progression of carotid atherosclerosis.
RESULTS: Progression of carotid atherosclerosis was found in 100 of 1,019 patients (9.8%). Myeloperoxidase (p = 0.014) but not HDL-C (p = 0.95) or LDL-C (p = 0.30) were associated with progressive disease. However, MPO  310 ng/ml was significantly associated with progressive disease (adjusted odds ratio [OR] 2.57, 95% confidence interval [CI] 1.39 to 4.75) only in patients with HDL-C levels <49 mg/dl. Otherwise, in patients with higher HDL-C levels (49 mg/dl), MPO 310 ng/ml did not predict disease progression (adjusted OR 1.42, 95% CI 0.72 to 2.78). No interaction of MPO with LDL-C was observed.
CONCLUSIONS: Myeloperoxidase was associated with progression of carotid atherosclerosis in patients with HDL cholesterol levels below 49 mg/dl.
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Abbreviations and Acronyms
| | CI = confidence interval | | CRP = C-reactive protein | | HDL-C = high-density lipoprotein cholesterol | | hs-CRP = high-sensitivity C-reactive protein | | ICA = internal carotid artery | | IQR = interquartile range | | LDL-C = low-density lipoprotein cholesterol | | MPO = myeloperoxidase | | OR = odds ratio | | SAA = serum amyloid A |
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