© 1997 American Heart Association, Inc.
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Elevated Circulating Levels of Inflammatory Cytokines in Patients With Abdominal Aortic Aneurysm
From the National Public Health Institute, Oulu (J.J., H-M.S, A.B., M.L., P.S.); the Department of Surgery, Oulu University Hospital and University of Oulu (J.S., T.J.); the Department of Internal Medicine, University of Helsinki, Helsinki (A-M.T.); Hospital Infection Control, Oulu University Hospital (H.S.); the Department of Internal Medicine, Division of Cardiology, Oulu University Hospital and University of Oulu (J.A.); and the Department of Internal Medicine, Central Hospital of Kainuu, Kajaani, Finland (J.J.).
Correspondence to Tatu Juvonen, MD, PhD, Research Asst Professor, Department of Cardiothoracic Surgery, The Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1028, New York, NY 10029.
Abstract The basic feature in the pathogenesis of abdominal
aortic aneurysm (AAA) is the degradation of extracellular
matrix components. This process is induced partly by cytokines
secreted from inflammatory and mesenchymal cells. Circulating levels of
inflammatory cytokines were studied in AAA patients and
compared with subjects suffering from atherosclerotic disease only.
Furthermore, the predictive value of cytokine concentrations
was evaluated for aneurysm expansion rate. Circulating levels
of interleukin 1ß (IL-1ß), interleukin 6 (IL-6), tumor necrosis
factor-
(TNF-), and interferon-
(IFN-) were measured in 50
AAA patients (40 men, 10 women), 42 patients with coronary
heart disease (CHD) (23 men, 19 women), and 38 controls whose angiogram
was normal (17 men, 21 women). No differences in cytokine
concentrations were found between the CHD patients and the controls.
AAA disease was found to be associated with significantly higher IL-
1ß and IL-6 concentrations in both male patients (median
concentrations of 19.40 pmol/L and 6.45 pmol/L, respectively) and
female patients (19.26 pmol/L and 7.99 pmol/L) than in either the CHD
patients or the controls (P<.005). TNF- levels were
slightly higher in the AAA patients (1.64 pmol/L in the males and 1.59
pmol/L in the females) than in the other groups (P <.05).
IFN- levels were elevated significantly in the female AAA patients
(3.75 pmol/L) compared with levels found in the other female
(P<.05) or male (P<.01) patient groups. The
measured cytokine concentrations were not related to the size
of the aneurysm or the maximal thickness of the thrombus within
the aneurysm. IFN- concentration showed a significant
positive correlation to the aneurysm expansion
(R=.37, P<.02) and negative correlation to the
concentration of aminoterminal propeptide of type III procollagen
during 6-month follow up (R=-.42, P<.005). The
results show that circulating levels of inflammatory cytokines
are elevated in patients with AAA disease, suggesting that the
production of these cytokines is increased in these
patients compared with CHD patients and controls. Elevated INF-
concentrations seem to predict an increased rate of expansion in AAA.
Key Words: cytokines • abdominal aortic aneurysm • inflammation
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