A new prognostic-predictor marker of cardiovascular disease for obstructive sleep apnea: pentraxin 3
2010
Obstructive sleep apnea syndrome (OSAS) is characterized by
intermittent complete or partial upper airway obstruction during sleep
causing hypoxia, sleep disruption, daytime sleepiness, mental and
physical effects is the second most common respiratory condition;
affecting 0.3- 4% of the middle- aged population (1). OSAS is strongly
associated with cardiovascular morbidity and mortality, including an
increased risk of endothelial dysfunction and atherosclerosis (2). The
increased prevalence of hypertension and atherogenesis among OSAS
patients has been attributed to sympathetic activation and endothelial
dysfunction, likely resulting from initiation and propagation of
inflammatory responses within the microvasculature (3). There is
increasing evidence that OSAS associated with inflammatory cytokines
and markers such as C-reactive protein (CRP), interleukin-6,
fibrinogen, tumor necrosis factor alpha which are closely-involved in
atherosclerosis, plaque formation and rupture (4). OSAS, a potent
activator of inflammation, inreases CRP which has been used as an
inflammatory biomarker for prediction of cardiovascular events;CRP is
named as classical short pentraxins and is a acute phase protein
produced from the liver in response to inflammatory mediators (5).
Pentraxin 3 (PTX3), a new defined member of the pentraxin family, is
produced from the major cell types involved in atherosclerotic lesions,
including vascular endothelial-smooth muscle cells, macrophages, and
neutrophils in response to inflammatory stimuli, however CRP is
produced only from liver (6,7). Furthermore, CRP represents a systemic
response to local inflammation, whereas PTX3 is rapidly produced
directly from damaged tissues and directly reflects only the
inflammatory state of the vasculature. The last but not the least PTX3
levels have been reported to be significantly elevated in acute
myocardial infarction (7). In the light of these knowledge, PTX3 is
able to reflect ACS condition better than CRP, it is highly possible
that PTX3 is a superior biomarker to predict future cardiovascular
events. Therefore, we speculate that OSAS, directly or indirectly,
induces a persisting systemic and vascular inflammation and may cause
PTX3 secretion. Since high PTX3 level is a sign of vascular
inflammation which is the trigger point for many diseases that may
occur secondary to OSAS, might also be a good marker of cardiovascular
disease in OSAS. Screening of PTX3 level in OSAS patients may be a
useful marker for evaluating the prognosis of OSAS. To address this
hypothesis, further prospective studies are warranted to evaluate the
role of PTX3 in patients with OSAS.
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