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Hellenic J Cardiol. 2019 May 2. pii: S1109-9666(18)30426-3. doi: 10.1016/j.hjc.2019.04.012. [Epub ahead of print]

Subgroups of monocytes predict cardiovascular events in patients with coronary heart disease. The PHAMOS trial (Prospective Halle Monocytes Study).

Author information

1
University Hospital Halle of the Martin-Luther-University Halle-Wittenberg, Mid-German Heart Center, Department of Medicine III, Germany. Electronic address: Florian.Hoepfner@uk-halle.de.
2
University Hospital Halle of the Martin-Luther-University Halle-Wittenberg, Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany.
3
University Hospital Halle of the Martin-Luther-University Halle-Wittenberg, Department of Medicine II, Germany.
4
University Hospital Halle of the Martin-Luther-University Halle-Wittenberg, Mid-German Heart Center, Department of Medicine III, Germany.
5
University Hospital Halle of the Martin-Luther-University Halle-Wittenberg, Department of Cardiothoracic Surgery, Germany.
6
University Hospital Halle of the Martin-Luther-University Halle-Wittenberg, Mid-German Heart Center, Department of Medicine III, Germany; Paracelsus Harz-Clinic Bad Suderode, Germany.

Abstract

BACKGROUND:

Monocytes can be differentiated by the presence of CD14 and CD16 (CD14++CD16-, classical; CD14++CD16+, intermediate and CD14 + CD16++, non-classical monocytes). Recent studies have reported conflicting results regarding an association between subtypes of monocytes as defined by the expression of these two surface markers in atherosclerosis.

METHODS:

We investigated subtypes of monocytes in n = 994 patients with angiographically documented coronary artery disease (CAD). We compared total numbers of monocyte subgroups stratified by tertiles with the occurrence of the pre-defined combined endpoint (non-fatal myocardial infarction, cardiovascular death and non-haemorrhagic cerebral insult). Patients were followed up for a minimum of 52 weeks. Classical risk factors of coronary heart disease were included in multivariate analysis.

RESULTS:

The primary endpoint occurred 134 times at a median time of 34.5 weeks (IR 10.6/59.6). Intermediate (p = 0.813), non-classical (p = 0.725) and the number of total monocytes (p = 0.626) stratified by tertiles showed no significant association with the combined endpoint. However, a higher absolute number of classical monocytes divided in tertiles was associated with incidence of the combined endpoint {T1 = 8.9% vs T2 = 14.2% vs T3 = 16.0% (p = 0.021)}. When comparing the third with the first tertile of Mo1 population, multivariate analysis showed a hazard ratio of 1.646 (CI: 1.005-2.699, p = 0.048).

CONCLUSIONS:

The absolute counts of classical monocytes divided in tertiles are predictive of major adverse cardiac events in patients with CAD. A tremendous shift from classical to intermediate monocytes was also confirmed in patients with CAD. These data highlight the importance of CD14++ monocytes in cardiovascular diseases.

KEYWORDS:

Atherosclerosis; CD14; CD16; Cardiovascular disease; Monocytes

PMID:
31055050
DOI:
10.1016/j.hjc.2019.04.012
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