Editors' ChoiceCardiovascular Disease

A Beacon of Danger

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Science Translational Medicine  09 Jan 2013:
Vol. 5, Issue 167, pp. 167ec8
DOI: 10.1126/scitranslmed.3005625

Among the most common causes of chest pain associated with heart disease are acute coronary syndromes, including angina pectoris (a transient blockage of the blood flow of the arteries that feed heart muscle) and acute myocardial infarction (severe and usually permanent blockage of blood flow accompanied by extensive muscle death). During these pathogenic processes, both vascular and muscle cells are damaged and die, leading to the release of molecules that can be measured in the blood. The dynamics of the circulating concentrations of some of these proteins in the acute phase of cardiovascular disease and their association with heart damage are well established. However, the medium- and long-term prognostic value of these biomarkers in heart disease patients remains unclear. Therefore, much effort has been expended on searching for new biomarker signatures that can more accurately predict heart disease progression. In a new study, Neri Serneri and co-workers report an association between the accumulation of oxidized low-density lipoprotein (oxLDL), which is the main transporter of cholesterol in the blood, and the severity of myocardial ischemia in patients with angina.

Increased concentrations of oxLDL are known to be associated with blood vessel wall inflammation and are also associated with enhanced formation of microvessels. Using histological and molecular techniques, Serneri et al. measured the expression of molecules related to oxLDL’s ability to scavenge cholesterol (the LDL receptor), molecules associated with tissue damage (cytokines) and formation of microvessels in cardiac biopsies from patients with stable or unstable angina. Notably, the investigators report a positive correlation between increased oxLDL and cytokines, increased formation of microvessels, and the severity of heart disease in patients with unstable angina.

This study sheds light on a potential mechanistic explanation for the pathological relationship between hypercholesterolemia and disease progression in patients with angina. These observations should be of value in the search for new biomarkers of cardiovascular disease. More extensive studies are required to confirm the new findings. Also, further stratification of patients with stable and unstable angina may provide comparative information on whether comorbidities can alter the associations observed.

G. G. Neri Serneri et al., Exaggerated myocardial oxLDL amount and LOX-1 receptor over-expression associated with coronary microvessel inflammation in unstable angina. Atherosclerosis, published online 12 December 2012 (10.1016/j.atherosclerosis.2012.11.007). [PubMed]

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