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(Circulation. 1996;94:874-877.)
© 1996 American Heart Association, Inc.


Articles

Elevated Levels of Interleukin-6 in Unstable Angina

Luigi M. Biasucci, MD; Alessandra Vitelli, BS; Giovanna Liuzzo, MD; Sergio Altamura, PhD; Giuseppina Caligiuri, MD; Claudia Monaco, MD; Antonio G. Rebuzzi, MD; Gennaro Ciliberto, MD; Attilio Maseri, MD

the Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy, and Istituto di Richerche di Biologia Molecolare "P Angeletti" (A.V., S.A., G. Ciliberto), Pomezia, Italy.

Correspondence to Luigi M. Biasucci, Istituto di Cardiologia, Universita' Cattolica, Largo Francesco Vito 1, 00168 Roma, Italy.

Background Elevated plasma levels of C-reactive protein have been found in the majority of patients with unstable angina. The evidence of elevated levels of acute-phase proteins in unstable angina is in line with a growing body of evidence that suggests that inflammation plays a role in this syndrome and is an indirect sign of increased production of interleukin-6, which is the major determinant of acute-phase–protein production by the liver. However, in unstable angina, there is no direct proof of the role played by interleukin-6.

Methods and Results We measured levels of interleukin-6 in 38 patients with unstable angina at the time of their admission to the coronary care unit and in 29 patients with stable angina. In the same groups of patients, we also measured C-reactive protein. Interleukin-6 (undetectable, ie, <3 pg/mL, in healthy volunteers) was detectable in 23 (61%) of 38 patients with unstable angina but in only 6 (21%) of 29 with stable angina (P<.01). Median interleukin-6 levels were 5.25 pg/mL (range, 0 to 90 pg/mL) in patients with unstable angina but were below the detection limit of the assay in patients with stable angina (range, 0 to 7 pg/mL). A significant correlation was observed between interleukin-6 and C-reactive protein levels (r=.4, P=.013).

Conclusions Our study demonstrates that raised levels of interleukin-6 are common in unstable angina, correlate with C-reactive protein, and are associated with prognosis, thus confirming the importance of the cytokine pathway for the production by the liver of acute-phase proteins and strengthening the importance of inflammation in this syndrome. Further studies are required to elucidate better the role of interleukins in unstable angina.


Key Words: interleukins • angina • proteins • prognosis • pathophysiology




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S. Matetzky, M. Domingo, S. Kar, M. Noc, P. K. Shah, S. Kaul, E. Daar, and B. Cercek
Acute Myocardial Infarction in Human Immunodeficiency Virus-Infected Patients
Arch Intern Med, February 24, 2003; 163(4): 457 - 460.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
S. Chia, C. A. Ludlam, K. A. A. Fox, and D. E. Newby
Acute systemic inflammation enhances endothelium-dependent tissue plasminogen activator release in men
J. Am. Coll. Cardiol., January 15, 2003; 41(2): 333 - 339.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
J Oldgren, L Wallentin, L Grip, R Linder, B.L Norgaard, and A Siegbahn
Myocardial damage, inflammation and thrombin inhibition in unstable coronary artery disease
Eur. Heart J., January 1, 2003; 24(1): 86 - 93.
[Abstract] [Full Text] [PDF]


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Eur Heart J SupplHome page
B. Schieffer
Interaction of interleukin-6 and angiotensin II in atherosclerosis: culprit for inflammation?
Eur. Heart J. Suppl., January 1, 2003; 5(suppl_A): A25 - A30.
[Abstract] [PDF]


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Nephrol Dial TransplantHome page
R. Pecoits-Filho, P. Barany, B. Lindholm, O. Heimburger, and P. Stenvinkel
Interleukin-6 is an independent predictor of mortality in patients starting dialysis treatment
Nephrol. Dial. Transplant., September 1, 2002; 17(9): 1684 - 1688.
[Abstract] [Full Text] [PDF]


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ANGIOLOGYHome page
M. E. Korkmaz, E. Tayfun, H. Muderrisoglu, A. Yildirir, B. Ozin, M. Ulucam, and M. Turan
Carbon Coating of Stents Has No Effect on Inflammatory Response to Primary Stent Deployment
Angiology, September 1, 2002; 53(5): 563 - 568.
[Abstract] [PDF]


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CirculationHome page
R. Altman, H. L. Luciardi, J. Muntaner, F. Del Rio, S. G. Berman, R. Lopez, and C. Gonzalez
Efficacy Assessment of Meloxicam, a Preferential Cyclooxygenase-2 Inhibitor, in Acute Coronary Syndromes Without ST-Segment Elevation: The Nonsteroidal Anti-Inflammatory Drugs in Unstable Angina Treatment-2 (NUT-2) Pilot Study
Circulation, July 9, 2002; 106(2): 191 - 195.
[Abstract] [Full Text] [PDF]


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NEJMHome page
A. Buffon, L. M. Biasucci, G. Liuzzo, G. D'Onofrio, F. Crea, and A. Maseri
Widespread Coronary Inflammation in Unstable Angina
N. Engl. J. Med., July 4, 2002; 347(1): 5 - 12.
[Abstract] [Full Text] [PDF]


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Anesth. Analg.Home page
C. D. Spies, H. Kern, T. Schroder, M. Sander, H. Sepold, P. Lang, K. Stangl, S. Behrens, P. Sinha, W. Schaffartzik, et al.
Myocardial Ischemia and Cytokine Response Are Associated with Subsequent Onset of Infections After Noncardiac Surgery
Anesth. Analg., July 1, 2002; 95(1): 9 - 18.
[Abstract] [Full Text] [PDF]


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J. Leukoc. Biol.Home page
C. Monaco, E. Andreakos, S. Young, M. Feldmann, and E. Paleolog
T cell-mediated signaling to vascular endothelium: induction of cytokines, chemokines, and tissue factor
J. Leukoc. Biol., April 1, 2002; 71(4): 659 - 668.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
F. Basso, G. D.O. Lowe, A. Rumley, A. D. McMahon, and S. E. Humphries
Interleukin-6 -174G>C Polymorphism and Risk of Coronary Heart Disease in West of Scotland Coronary Prevention Study (WOSCOPS)
Arterioscler Thromb Vasc Biol, April 1, 2002; 22(4): 599 - 604.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
R. Kell, A. Haunstetter, T.J. Dengler, C. Zugck, W. Kubler, and M. Haass
Do cytokines enable risk stratification to be improved in NYHA functional class III patients?. Comparison with other potential predictors of prognosis
Eur. Heart J., January 1, 2002; 23(1): 70 - 78.
[Abstract] [Full Text] [PDF]


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StrokeHome page
M. S. Elkind, J. Cheng, B. Boden-Albala, T. Rundek, J. Thomas, H. Chen, L. E. Rabbani, R. L. Sacco, and A. G. Thrift
Tumor Necrosis Factor Receptor Levels Are Associated With Carotid Atherosclerosis * Editorial Comment
Stroke, January 1, 2002; 33(1): 31 - 38.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
N. Lamblin, C. Bauters, and N. Helbecque
Gene polymorphisms of pro- (or anti-) inflammatory cytokines and vascular disease
Eur. Heart J., December 2, 2001; 22(24): 2219 - 2220.
[PDF]


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Eur Heart JHome page
S.E. Humphries, L.A. Luong, M.S. Ogg, E. Hawe, and G.J. Miller
The interleukin-6 -174 G/C promoter polymorphism is associated with risk of coronary heart disease and systolic blood pressure in healthy men
Eur. Heart J., December 2, 2001; 22(24): 2243 - 2252.
[Abstract] [PDF]


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HeartHome page
C D Garlichs, S Eskafi, D Raaz, A Schmidt, J Ludwig, M Herrmann, L Klinghammer, W G Daniel, and A Schmeisser
Patients with acute coronary syndromes express enhanced CD40 ligand/CD154 on platelets
Heart, December 1, 2001; 86(6): 649 - 655.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
G. K. Hansson
Immune Mechanisms in Atherosclerosis
Arterioscler Thromb Vasc Biol, December 1, 2001; 21(12): 1876 - 1890.
[Abstract] [Full Text] [PDF]


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JAMAHome page
E. Lindmark, E. Diderholm, L. Wallentin, and A. Siegbahn
Relationship Between Interleukin 6 and Mortality in Patients With Unstable Coronary Artery Disease: Effects of an Early Invasive or Noninvasive Strategy
JAMA, November 7, 2001; 286(17): 2107 - 2113.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
T. Tokunou, T. Ichiki, K. Takeda, Y. Funakoshi, N. Iino, H. Shimokawa, K. Egashira, and A. Takeshita
Thrombin Induces Interleukin-6 Expression Through the cAMP Response Element in Vascular Smooth Muscle Cells
Arterioscler Thromb Vasc Biol, November 1, 2001; 21(11): 1759 - 1763.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
M. I. Furman, M. R. Barnard, L. A. Krueger, M. L. Fox, E. A. Shilale, D. M. Lessard, P. Marchese, A. L. Frelinger III, R. J. Goldberg, and A. D. Michelson
Circulating monocyte-platelet aggregates are an early marker of acute myocardial infarction
J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1002 - 1006.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
D.J. Brull, H.E. Montgomery, J. Sanders, S. Dhamrait, L. Luong, A. Rumley, G.D.O. Lowe, and S.E. Humphries
Interleukin-6 Gene -174G>C and -572G>C Promoter Polymorphisms Are Strong Predictors of Plasma Interleukin-6 Levels After Coronary Artery Bypass Surgery
Arterioscler Thromb Vasc Biol, September 1, 2001; 21(9): 1458 - 1463.
[Abstract] [Full Text] [PDF]


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CirculationHome page
D. A. Smith, S. D. Irving, J. Sheldon, D. Cole, and J. C. Kaski
Serum Levels of the Antiinflammatory Cytokine Interleukin-10 Are Decreased in Patients With Unstable Angina
Circulation, August 14, 2001; 104(7): 746 - 749.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
G. Valen, Z.-q. Yan, and G.o. K. Hansson
Nuclear factor kappa-B and the heart
J. Am. Coll. Cardiol., August 1, 2001; 38(2): 307 - 314.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
G. Plenz, Z. F. Song, T. D.T. Tjan, C. Koenig, H. A. Baba, M. Erren, M. Flesch, T. Wichter, H. H. Scheld, and M. C. Deng
Activation of the cardiac interleukin-6 system in advanced heart failure
Eur J Heart Fail, August 1, 2001; 3(4): 415 - 421.
[Abstract] [Full Text] [PDF]


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JAMAHome page
R. J. Simpson Jr
Placing PRINCE in Perspective
JAMA, July 4, 2001; 286(1): 91 - 93.
[Full Text] [PDF]


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Eur Heart JHome page
T O'malley, C.A Ludlam, R.A Riemermsa, and K.A.A Fox
Early increase in levels of soluble inter-cellular adhesion molecule-1 (sICAM-1). Potential risk factor for the acute coronary syndromes
Eur. Heart J., July 2, 2001; 22(14): 1226 - 1234.
[Abstract] [PDF]


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J Am Coll CardiolHome page
G. G. Neri Serneri, M. Boddi, L. Poggesi, I. Simonetti, M. Coppo, M. L. Papa, G. F. Lisi, M. Maccherini, R. Becherini, A. Boncompagni, et al.
Activation of cardiac renin-angiotensin system in unstable angina
J. Am. Coll. Cardiol., July 1, 2001; 38(1): 49 - 55.
[Abstract] [Full Text] [PDF]


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CirculationHome page
S. Blankenberg, H. J. Rupprecht, C. Bickel, C. Espinola-Klein, G. Rippin, G. Hafner, M. Ossendorf, K. Steinhagen, and J. Meyer
Cytomegalovirus Infection With Interleukin-6 Response Predicts Cardiac Mortality in Patients With Coronary Artery Disease
Circulation, June 19, 2001; 103(24): 2915 - 2921.
[Abstract] [Full Text] [PDF]


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CirculationHome page
G. Liuzzo, D. J. Angiolillo, A. Buffon, V. Rizzello, C. Colizzi, F. Ginnetti, L. M. Biasucci, and A. Maseri
Enhanced Response of Blood Monocytes to In Vitro Lipopolysaccharide-Challenge in Patients With Recurrent Unstable Angina
Circulation, May 8, 2001; 103(18): 2236 - 2241.
[Abstract] [Full Text] [PDF]


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HeartHome page
A Mazzone, S De Servi, I Mazzucchelli, I Bossi, E Ottini, M Vezzoli, F Meloni, M Lotzinker, and G Mariani
Increased concentrations of inflammatory mediators in unstable angina: correlation with serum troponin T
Heart, May 1, 2001; 85(5): 571 - 575.
[Abstract] [Full Text]


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CirculationHome page
G. Liuzzo, A. N. Vallejo, S. L. Kopecky, R. L. Frye, D. R. Holmes, J. J. Goronzy, and C. M. Weyand
Molecular Fingerprint of Interferon-{{gamma}} Signaling in Unstable Angina
Circulation, March 20, 2001; 103(11): 1509 - 1514.
[Abstract] [Full Text] [PDF]


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CirculationHome page
S. Volpato, J. M. Guralnik, L. Ferrucci, J. Balfour, P. Chaves, L. P. Fried, and T. B. Harris
Cardiovascular Disease, Interleukin-6, and Risk of Mortality in Older Women : The Women's Health and Aging Study
Circulation, February 20, 2001; 103(7): 947 - 953.
[Abstract] [Full Text] [PDF]


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CirculationHome page
J. A. Shaw, J. P. F. Chin-Dusting, B. A. Kingwell, and A. M. Dart
Diurnal Variation in Endothelium-Dependent Vasodilatation Is Not Apparent in Coronary Artery Disease
Circulation, February 13, 2001; 103(6): 806 - 812.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
J. Figueras, Y. Monasterio, R. M. Lidon, E. Nieto, and J. Soler-Soler
Thrombin formation and fibrinolytic activity in patients with acute myocardial infarction or unstable angina: in-hospital course and relationship with recurrent angina at rest
J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2036 - 2043.
[Abstract] [Full Text] [PDF]


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Journals of Gerontology Series A: Biological Sciences and Medical SciencesHome page
D. R. Taaffe, T. B. Harris, L. Ferrucci, J. Rowe, and T. E. Seeman
Cross-sectional and Prospective Relationships of Interleukin-6 and C-Reactive Protein With Physical Performance in Elderly Persons: MacArthur Studies of Successful Aging
J. Gerontol. A Biol. Sci. Med. Sci., December 1, 2000; 55(12): 709M - 715.
[Abstract] [Full Text]


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Arterioscler. Thromb. Vasc. Bio.Home page
R. Rauramaa, S. B. Vaisanen, L.-A. Luong, A. Schmidt-Trucksass, I. M. Penttila, C. Bouchard, J. Toyry, and S. E. Humphries
Stromelysin-1 and Interleukin-6 Gene Promoter Polymorphisms Are Determinants of Asymptomatic Carotid Artery Atherosclerosis
Arterioscler Thromb Vasc Biol, December 1, 2000; 20(12): 2657 - 2662.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
D. Zanger, B. K. Yang, J. Ardans, M. A. Waclawiw, G. Csako, L. M. Wahl, and R. O. Cannon III
Divergent effects of hormone therapy on serum markers of inflammation in postmenopausal women with coronary artery disease on appropriate medical management
J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1797 - 1802.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
A. Woods, D.J. Brull, S.E. Humphries, and H.E. Montgomery
Genetics of inflammation and risk of coronary artery disease: the central role of interleukin-6
Eur. Heart J., October 1, 2000; 21(19): 1574 - 1583.
[PDF]


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J Am Coll CardiolHome page
E. Braunwald, E. M. Antman, J. W. Beasley, R. M. Califf, M. D. Cheitlin, J. S. Hochman, R. H. Jones, D. Kereiakes, J. Kupersmith, T. N. Levin, et al.
ACC/AHA guidelines for the management of patients with unstable angina and non-st-segment elevation myocardial infarction: A report of the american college of cardiology/ american heart association task force on practice guidelines (committee on the management of patients with unstable angina)
J. Am. Coll. Cardiol., September 1, 2000; 36(3): 970 - 1062.
[Full Text] [PDF]