Should We “Tweak” Our Approach to Coronary Artery Disease?

Coronary Artery Disease; Atherosclerosis; Cardiovascular Diseases/mortality; Biomarkers; Biomedical, Technology/trends

Despite our great advances in medical technology, Cardiovascular Disease remains the leading cause of death worldwide. Coronary Artery Disease (CAD) is one of the hallmarks.¹

It is believed that the first correlation between coronary flow and angina pectoris was made by William Heberden in 1768, but its anatomical remarks were only described by 1829, when Jean Lobstein introduced the term Arteriosclerosis, reporting an abnormal formation in arterial walls.² Later, in 1856, Rudolph Virchow suggested an arterial wall injury mechanism that could explain those findings from a cellular pathology compound.³ However, it was only until the 20^thcentury, in the late 70´s, that the consortium of endothelial damage-wall shear stress-smooth muscle proliferation-thrombogenesis was first elucidated in the “Response to Injury Hypothesis” by Ross et al..⁴

Modern cardiology has evolved exponentially since those first discoveries, offering state-of-the-art technology to treat the full range of Acute Coronary Syndromes.⁵ , ⁶ Our better comprehension of this disease’s complex molecular dynamics is fundamental to improving an early diagnosis and further, preventing its disastrous outcomes.⁷

21^st-century medicine offers a great armamentarium of molecular diagnoses for several diseases, but CAD is somewhat lacking behind.⁸

It is widely known that inflammation plays a major role in atherogenesis;⁹ thus, several biomarkers have been studied in this context, such as C-reactive Protein, Interleukin (IL)6, Tumor Necrosis Factor (TNF) alfa, among others.¹⁰ One of these tools’ mean issues is the lack of specificity or its right association with net mortality.

In this issue, Tatlisu et al.¹³ contemplate using soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK), a known player in proliferation and inflammation,¹⁴ to elucidate coronary artery calcification.

In a prospective study, 139 consecutive patients with Chronic Kidney Disease (CKD) were included with further computed coronary angiography (CCA) for coronary artery calcium (CAC) score analysis. Blood samples were collected to analyze sTWEAK, where they sought the relationship with the CAC score. They found that as the CAC score increased, sTWEAK levels decreased significantly. Furthermore, they concluded that low sTWEAK levels were a predictor of high CAC scores in their studied population.

It is quite early to start adopting these new biomarkers as a standard for CAD diagnosis in our clinical practice; however, these kinds of efforts drive us to an enhanced view of the complex dynamic of CAD, walking us to the near future of precision medicine, when we could finally have a tweak to the disease itself.

Referências

• ¹
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  Furie MB, Mitchell RN. Plaque attack. Am J Pathol. 2012;180(6):2184-7. doi:10.1016/j.ajpath.2012.04.003
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  Mayerl C, Lukasser M, Sedivy R, Niederegger H, Seiler R, Wick G. Atherosclerosis research from past to present—on the track of two pathologists with opposing views, Carl von Rokitansky and Rudolf Virchow. Virchows Arch. 2006;449(1):96-103. doi:10.1007/s00428-006-0176-7
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  Ross RR, Glomset J, Harker L. Response to injury and atherogenesis. Am J Pathol. 1977;86(3):10. PMID:842616
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  Cedro AV, Mota DM, Ohe LN, Timerman A, Costa JR, Castro L de S. Associação entre Escores de risco clínico (HEART, GRACE e TIMI) e complexidade angiográfica na síndrome coronária aguda sem elevação do segmento ST. Arq Bras Cardiol. 2021;117(2):281-7. doi:10.36660/abc.20190417
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  Correia L, Lopes D, Porto JV, Lacerda Y, Correia V, Correia L, et al. Validação de um Algoritmo de Inteligência Artificial para a Predição Diagnóstica de Doença Coronariana: Comparação com um Modelo Estatístico Tradicional. Arq Bras Cardiol. 2021;117(6):1061-70. doi:10.36660/abc.20200302
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  Souza VF, Santos AASMD dos, Mesquita CT, Martins WA, Pelandre GL, Mesquita C, et al. Quantificação das placas coronarianas calcificadas pela tomografia computadorizada do tórax: correlação com a técnica do escore de cálcio. Arq Bras Cardiol. 2020;115(3):493-500. doi:10.36660/abc.20190235
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  Scherr C, Albuquerque DC de, Pozzan R, Ataide K, Ludmila T, Blanco F, et al. Papel da Interleucina 18 e da Proteína precursora do trombo na doença arterial coronariana. Arq Bras Cardiol.2020;020;114(4):692-8. doi:10.36660/abc.20190176
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• ¹¹
  Ilgın BU, Kızıltunç E, Gök M, Ornek E, Topcuoglu C, Çetin N, et al. Associação entre os níveis séricos se serglicina e o infarto do miocárdio com supradesnivelamento do segmento ST. Arq Bras Cardiol. 2021;116(4):756-62. doi:10.36660/abc.20190554
  » https://doi.org/10.36660/abc.20190554
• ¹²
  May BM, Pimentel M, Zimerman LI, Rohde LE. GDF-15 como biomarcador em doenças cardiovasculares. Arq Bras Cardiol.2021;116(3):494-500. doi:10.36660/abc.20200426
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• ¹³
  Tatlisu MA, Atici A, Ozcan FB, Çelik M, Kirac E, Baycan OF, et al. A Associação de TWEAK com calcificação da artéria coronária em pacientes com doença renal crônica. Arq Bras Cardiol. 2022; 119(3):436-445.
• ¹⁴
  Carrero JJ, Ortiz A, Qureshi AR, Martin-Ventura J, Barany P, Heimburger O. et al. Additive Effects of Soluble TWEAK and Inflammation on Mortality in Hemodialysis Patients. CJASN. 2009;4(1):110-8. doi:10.2215/CJN.02790608
  » https://doi.org/10.2215/CJN.02790608

• Short Editorial related to the article: The Association of TWEAK with Coronary Artery Calcification in Patients with Chronic Kidney Disease

Publication Dates

• Publication in this collection
  05 Sept 2022
• Date of issue
  Sept 2022