Thromb Haemost 2015; 114(03): 519-529
DOI: 10.1160/TH14-12-1007
Theme Issue Article
Schattauer GmbH

The influence of low-grade inflammation on platelets in patients with stable coronary artery disease

Sanne Bøjet Larsen
1   Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
,
Erik Lerkevang Grove
1   Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
,
Morten Würtz
1   Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
,
Søs Neergaard-Petersen
1   Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
,
Anne-Mette Hvas
2   Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
3   Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
,
Steen Dalby Kristensen
1   Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
3   Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
› Author Affiliations

Financial support: SDK and ELG have received financial support from the Danish Agency for Science Technology and Innovation (grant no. 2101–05–0052) and SDK has received support from the Novo Nordisk Foundation.
Further Information

Publication History

Received: 02 December 2014

Accepted after major revision: 07 May 2015

Publication Date:
21 November 2017 (online)

Preview

Summary

Inflammation is likely to be involved in all stages of atherosclerosis. Numerous inflammatory biomarkers are currently being studied, and even subtle increases in inflammatory biomarkers have been associated with increased risk of cardiovascular events in patients with coronary artery disease (CAD). Low-grade inflammation may influence both platelet production and platelet activation potentially leading to enhanced platelet aggregation. Thrombopoietin is considered the primary regulator of platelet production, but it likely acts in conjunction with numerous cytokines, of which many have altered levels in CAD. Previous studies have shown that high-sensitive C-reactive protein (CRP) independently predicts increased platelet aggregation in stable CAD patients. Increased levels of CRP, fibrinogen, interleukin-6, stromal cell-derived factor-1, CXC motif ligand 16, macrophage migration inhibitory factor, RANTES, calprotectin, and copeptin have been associated with increased risk of cardiovascular events in CAD patients. Additionally, some of these inflammatory markers have been associated with enhanced platelet activation and aggregation. However, CRP and other inflammatory markers provide only limited additional predictive value to classical risk factors such as smoking, blood pressure, and cholesterol levels. Existing data do not clarify whether inflammation simply accompanies CAD and increased production and aggregation of platelets, or whether a causal relationship exists. In this review, we provide a comprehensive overview of inflammatory markers in stable CAD with particular emphasis on platelet production, activation, and aggregation in CAD patients.