Researchers at the Karolinska Institute have identified a potential new risk marker for cardiovascular disease in women. Findings from the Swedish Mammography Cohort study, published in the Journal of the American College of Cardiology, reveal that low levels of anti-inflammatory antibodies, specifically those targeting the fatty substance phosphorylcholine (anti-PC), are linked to an increased risk of heart attack and coronary heart disease.
Atherosclerosis, a leading cause of cardiovascular disease, is characterized by an inflammatory condition affecting the arterial intima, where plaques form. These plaques, featuring a necrotic core of dead cells derived from foam cells and macrophages filled with oxidized low-density lipoprotein (OxLDL), play a crucial role in disease progression. Phosphorylcholine (PC), a small hapten found in cell membranes and lipoproteins, is key to this process. Anti-PC antibodies, present in high levels in human circulation, specifically recognize PC when exposed to dead cells or OxLDL. This recognition drives immune activation and contributes to the pro-inflammatory effects of atherosclerosis.
Women often face additional cardiovascular risk factors such as high blood pressure, diabetes, and heart failure. While previous research has shown an association between low anti-PC levels and cardiovascular risk in men, this study shifts the focus to women. Over a 16-year follow-up period, totaling 13,033 person-years, the study identified 113 cases of composite cardiovascular disease, 69 cases of ischemic heart disease (IHD), 44 cases of myocardial infarction (MI), and 50 cases of ischemic stroke. Notably, results demonstrated a statistically significant inverse association between IgM anti-PC levels and the risk of CVD, IHD, and MI. However, no significant relationship was found between IgM anti-PC levels and the risk of ischemic stroke.
In a compelling finding, when comparing the highest tertile of anti-PC levels to the lowest, researchers observed a multivariable-adjusted hazard ratio of 0.27 (95% CI: 0.11-0.68; P trend <0.01) for myocardial infarction, suggesting that higher levels of IgM anti-PC are linked to a significantly reduced risk of this serious condition.
Despite these promising results, researchers have yet to determine the exact threshold of anti-PC levels that would be considered protective. The Karolinska Institute’s study represents a crucial advancement in understanding cardiovascular health in women. By identifying anti-PC antibodies as a potential risk marker, researchers are paving the way for new preventive measures and treatment strategies. As this research progresses, it holds the promise of transforming the assessment and management of cardiovascular risk, particularly among women who face unique health challenges.
References
- Antibodies Against Phosphorylcholine in Prediction of Cardiovascular Disease Among Women [Internet]. [cited 2024 Oct 10]. Available from: https://www.jacc.org/doi/epdf/10.1016/j.jacadv.2024.101298
- Frostegård J. Antibodies against phosphorylcholine and protection against atherosclerosis, cardiovascular disease, and chronic inflammation. Expert Rev Clin Immunol. 2022 May;18(5):525–32.
- Frostegård J. Immunity, atherosclerosis and cardiovascular disease. BMC Medicine. 2013 May 1;11(1):117.