Myeloperoxidase activity affects the high-density lipoprotein cholesterol level and the course of chronic coronary heart disease in patients with arterial hypertension

Abstract

BACKGROUND: Coronary heart disease is one of the leading causes of death and disability worldwide. Myeloperoxidase plays the key role in its pathogenesis. Oxidative modification of high-density lipoprotein particles by myeloperoxidase followed by impaired reverse cholesterol transport and the decrease of high-density lipoprotein cholesterol level results in atherosclerosis progression. We studied the effect of myeloperoxidase on reverse cholesterol transport among patients with arterial hypertension and different clinical forms of chronic coronary heart disease, judging by findings in blood plasma.

AIM: The ultimate goal was to establish whether that effect is associated with the total amount of myeloperoxidase or its activity.

METHODS: 93 patients were recruited (65.4 ± 10.1 years old in average; men — 30 (32%)) with arterial hypertension and different clinical forms of chronic coronary heart disease. Depending on the diagnosis established, all participants were divided into 3 groups. Group I (control) contained patients with arterial hypertension, but without chronic coronary heart disease (n = 46). Group II (n = 26) included patients with initially stable coronary syndromes of chronic coronary heart disease (stable angina and/or scheduled surgical interventions for stable coronary heart disease), who never experienced acute adverse cardiac events. Group III (n = 21) contained patients with acute coronary syndrome (acute myocardial infarction) in the past 6 months or earlier. The total myeloperoxidase content (MPO-T) was assayed by enzyme-linked immunosorbent assay (ELISA). Home-modified specific immune-extraction followed by enzymatic detection (SIEFED) test was used to measure the active myeloperoxidase (MPO-A). Then, the coefficient of myeloperoxidase activity (MPO-CA) and the ratio of coefficient of myeloperoxidase activity to high-density lipoprotein cholesterol (MPO-CA/HDL-C) were calculated.

RESULTS: The level of MPO-A was higher in patients from group III with complicated form of chronic coronary heart disease, as compared with group II (p < 0.05). MPO-CA in patients of group III also was higher in comparison with group II (p = 0.001). Weak positive correlation was found between MPO-T and MPO-A in the whole cohort under investigation (r = 0.26; p < 0.05), and the relationship was stronger in the group III (r = 0.59; p < 0.05). In addition, negative correlation between MPO-A and HDL-C was found in group III (r = –0.46; p < 0.05). The MPO-CA/HDL-C ratio was higher in patients with anamnestic acute coronary syndrome, as compared with patients manifesting non-complicated stable coronary heart disease (p < 0.001) and with patients of group I who had no coronary heart disease (p < 0.001). To determine diagnostic value of the MPO-CA/HDL-C the receiver operating characteristic curve (ROC-curve) was plotted. The calculated area under curve (AUC) was 0.8 which indicates a high predictive value of the MPO-CA/HDL-C ratio for different forms of chronic coronary heart disease.

CONCLUSION: The results of our study demonstrate that in patients with preceding history of acute coronary syndrome, as compared with those having a stable course of chronic coronary heart disease, the effect of myeloperoxidase on reverse cholesterol transport depends on its activity rather than concentration. MPO-CA/HDL-C ratio mirrors the complicated chronic coronary heart disease and might serve as an additional indicator of residual risk.

Keywords

myeloperoxidase / high-density lipoprotein cholesterol / coronary heart disease / reverse cholesterol transport / ELISA / SIEFED

References

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