Abstract 12424: Antibodies to Malondialdehyde Oxidized LDL Predict Cardiovascular Events During Log-Term Follow-Up In High Risk Coronary Artery Disease Patients
Background. Low-density lipoproteins (LDLs) accumulate in the sub-endothelial extracellular space where they are transformed by macrophages to oxidized LDL (oxLDL). OxLDL are held to play a key role in the atherosclerotic process initiation and progression and to expose immunogenic epitopes, which induce formation of antibodies against malondialdehyde oxLDL (MDA-oxLDLAbs). Even though MDA-oxLDLAbs are detectable in sera of the majority of patients with advanced atherosclerotic lesions, it remains controversial if they play a pathogenic or a protective role. Taking advantage of a prospective cohort study we therefore investigated whether MDA-oxLDLAbs predict cardiovascular (CV) events during long-term follow-up.
Methods. In 384 consecutive Caucasian patients of the GENICA Study, who underwent coronary angiography and measurement of IgG MDA-oxLDLAbs titer by ELISA, we determined the incidence of CV events (acute coronary syndromes, stroke, CV death) at follow-up. Patients were stratified by quartiles of oxLDLAbs titer. Kaplan-Meier and Cox regression analyses were used to compare quartiles for event-free survival after correcting for the effect of confounding variables with propensity score.
Results. Complete follow-up data were obtained in 318 (82%) patients. After a median follow-up of 7.6 years (IQ range 0.1-12.7 days) 85 (27%) CV events were seen. Increasing titer of MDA-oxLDLAbs was associated to a worse CV event-free survival (p=0.001) at Kaplan-Meier analysis. Cox regression analysis, besides confirming the known adverse effect of the coronary atherosclerotic burden (Duke CAD score) (p=0.027) and left ventricular ejection fraction (p=0.005), also evidenced an unfavorable impact of high MDA-oxLDLAbs on CV events (Exp(B) = 1.43, CI 1.11-1.83, p=0.004.
Conclusions. A high titer of MDA-oxLDLAbs conveys independent prognostic information in high-risk Caucasian patients referred for coronary angiography.
- © 2011 by American Heart Association, Inc.