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(Circulation. 2005;112:812-818.)
© 2005 American Heart Association, Inc.

Coronary Heart Disease

Serum Soluble Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 Levels Are Elevated in Acute Coronary Syndrome

A Novel Marker for Early Diagnosis

Kazutaka Hayashida, MD, PhD; Noriaki Kume, MD, PhD; Takatoshi Murase, PhD; Manabu Minami, MD, PhD; Daisuke Nakagawa, MD; Tsukasa Inada, MD, PhD; Masaru Tanaka, MD, PhD; Akira Ueda; Goro Kominami, PhD; Hirofumi Kambara, MD, PhD; Takeshi Kimura, MD, PhD; Toru Kita, MD, PhD

From the Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto (K.H., N.K., T.M., M.M., T.K., T.K.); Cardiovascular Center, Osaka Red Cross Hospital, Osaka (D.N., T.I., M.T., H.K.); and Developmental Research Laboratories, Shionogi & Co Ltd, Osaka (A.U., G.K.), Japan. Dr Kambara currently is Director at Shizuoka General Hospital, Shizuoka, Japan.

Correspondence to Noriaki Kume, MD, PhD, Associate Professor, Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. E-mail nkume{at}kuhp.kyoto-u.ac.jp

Received May 3, 2004; revision received March 15, 2005; accepted April 5, 2005.

Background— Markers of cardiac injury, including troponin-T (TnT), are used to diagnose acute coronary syndrome (ACS); however, markers for plaque instability may be more useful for diagnosing ACS at the earliest stage. Lectin-like oxidized LDL receptor-1 (LOX-1) appears to play crucial roles in the pathogenesis of atherosclerotic plaque rupture and ACS onset. LOX-1 is released in part as soluble LOX-1 (sLOX-1) by proteolytic cleavage.

Methods and Results— We examined serum sLOX-1 levels in 521 patients, consisting of 427 consecutive patients undergoing coronary angiography, including 80 ACS patients, 173 symptomatic coronary heart disease patients, 122 patients with significant coronary stenosis without ischemia, and 52 patients without apparent coronary atherosclerosis plus 34 patients with noncardiac acute illness and 60 patients with noncardiac chronic illness. Time-dependent changes in sLOX-1 and TnT levels were analyzed in an additional 40 ACS patients. Serum sLOX-1 levels were significantly higher in ACS than the other groups and were associated with ACS as shown by multivariable logistic regression analyses. Given a cutoff value of 1.0 ng/mL, sLOX-1 can discriminate ACS from other groups with 81% and 75% of sensitivity and specificity, respectively. sLOX-1 can also discriminate ACS without ST elevation or abnormal Q waves and ACS without TnT elevation from non-ACS with 91% and 83% of sensitivity, respectively. Peak values of sLOX-1 in ACS were observed earlier than those of TnT.

Conclusions— sLOX-1 appears to be a useful marker for early diagnosis of ACS.

Key Words: angina • atherosclerosis • lipoproteins • myocardial infarction • receptors

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