endothelin-1 and Acute-Coronary-Syndrome

To systematically evaluate the efficacy and safety of Danhong injection (DH) in treating acute coronary syndrome (ACS), randomized controlled trials (RCTs) regarding ACS treated by DH were searched in Chinese and English electronic databases from inception until June 2013. Two reviewers independently retrieved RCTs and extracted information. The Cochrane risk of bias method was used to assess the quality of the included studies, and a meta-analysis was conducted with Review Manager 5.2 software. About 26 RCTs with 2660 participants were included. The methodological quality was usually not high, and only one study used a randomized, double-blinded method. The meta-analysis indicated that on the basis of conventional therapy with Western medicine (WM), DH was more effective in increasing the total effective rate [RR = 1.24, 95%CI (1.17, 1.32), p < 0.00001]. Additionally, DH can decrease inflammatory cytokines, including high sensitive C-reactive protein (Hs-CRP) and interleukin-6 (IL-6), lower plasma viscosity, plasma endothelin-1 (ET-1) and brain natriuretic peptide (BNP), reduce the generation of myeloperoxidase (MPO), and decrease the number of T-wave inversion. There were no adverse drug reactions (ADR) reported in the experimental group, while one case occurred in the control group. Based on the systematic review, DH combined with WM was effective in the treatment of ACS. However, the safety of DH in the treatment of ACS should be further carefully interpreted by more large-scale and double-blind RCTs.

Topics: Acute Coronary Syndrome; Blood Viscosity; C-Reactive Protein; Databases, Bibliographic; Double-Blind Method; Drugs, Chinese Herbal; Endothelin-1; Humans; Inflammation Mediators; Injections; Interleukin-6; Natriuretic Peptide, Brain; Peroxidase; Randomized Controlled Trials as Topic; Treatment Outcome

Psychological constructs are associated with cardiovascular health, but the biological mechanisms mediating these relationships are unknown. We examined relationships between psychological constructs and markers of inflammation, endothelial function, and myocardial strain in a cohort of post-acute coronary syndrome (ACS) patients.. Participants (N = 164) attended study visits 2 weeks and 6 months after ACS. During these visits, they completed self-report measures of depressive symptoms, anxiety, optimism, and gratitude; and blood samples were collected for measurement of biomarkers reflecting inflammation, endothelial function, and myocardial strain. Generalized estimating equations and linear regression analyses were performed to examine concurrent and prospective relationships between psychological constructs and biomarkers.. In concurrent analyses, depressive symptoms were associated with elevated markers of inflammation (interleukin-17: β = .047; 95% confidence interval [CI] = .010-.083]), endothelial dysfunction (endothelin-1: β = .020; 95% [CI] = .004-.037]), and myocardial strain (N-terminal pro-B-type natriuretic peptide: β = .045; 95% [CI] = .008-.083]), independent of age, sex, medical variables, and anxiety, whereas anxiety was not associated with these markers in multivariable adjusted models. Optimism and gratitude were associated with lower levels of markers of endothelial dysfunction (endothelin-1: gratitude: β = -.009; 95% [CI] = -.017 to - .001]; optimism: β = -.009; 95% [CI] = -.016 to - .001]; soluble intercellular adhesion molecule-1: gratitude: β = -.007; 95% [CI] = -.014 to - .000]), independent of depressive and anxiety symptoms. Psychological constructs at 2 weeks were not prospectively associated with biomarkers at 6 months.. Depressive symptoms were associated with more inflammation, myocardial strain, and endothelial dysfunction in the 6 months after ACS, whereas positive psychological constructs were linked to better endothelial function. Larger prospective studies may clarify the directionality of these relationships.. Clinicaltrials.gov identifier NCT01709669.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Depression; Endothelin-1; Female; Follow-Up Studies; Humans; Inflammation; Intercellular Adhesion Molecule-1; Interleukin-17; Male; Middle Aged; Natriuretic Peptide, Brain; Optimism; Peptide Fragments

To observe the effect and explore the action mechanism of Danhong Injection (DHI) on serum levels of endothelin-1 (ET-1), soluble P-selectin (sP-sel) and high sensitivity C-reactive protein (hs-CRP) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).. Seventy ACS patients scheduled to receive PCI were assigned to two groups. Around PCI, the 34 patients in the control group were treated with conventional therapy and the 36 in the DHI group treated with conventional therapy combined with DHI treatment given from the day of PCI to the 14th day after operation at the dose of 40 mL per day by dissolving in 250 mL of 5% glucose for venous dripping. Plasma levels of ET-1, sP-sel and hs-CRP were detected using ELISA at various time points: before PCI (T0), after PCI (T1), 24 h (T2) and 2 weeks (T3) after PCI. The outcomes were compared between the two groups, and compared with those obtained from 20 healthy persons set as the normal control.. All the three indices in the two patients' group at T0, T1 and T2 were higher than those in the normal control respectively (P < 0.01), while at T3, the indices in the DHI group were lower than the normal control (P > 0.05). Comparisons between the two patients' group showed that the indices were not different at TO, T1 and T2, but at T3, all were lower in the DHI group than in the control group (P < 0.05, P < 0.01).. Combined conventional therapy with DHI for 2 weeks can significantly reduce the plasma levels of ET-1, sP-sel and hs-CRP in ACS patients after PCI, suggesting that DHI has certain effects in protecting the endothelial function, inhibiting platelet activation and suppressing inflammatory reaction.

Topics: Acute Coronary Syndrome; Adult; Aged; C-Reactive Protein; Drugs, Chinese Herbal; Endothelin-1; Female; Humans; Male; Middle Aged; P-Selectin; Percutaneous Coronary Intervention

To evaluate the effect of urapidil on myocardial perfusion, and ventricular function in patients with ST-elevation acute coronary syndrome (ACS) treated with primary percutaneous coronary intervention (PCI).. Fifty-four patients were randomized into urapidil (12.5 mg, ic, n=27) or control group. Infarct related artery (IRA) was targeted with PCI following urapidil administration. TIMI blood flow, corrected TIMI frame count (cTFC), myocardial blush grade (MBG), ST resolution (STR) on ECG, creatine kinase MB (CK-MB) and cardiac troponin T (cTnT) were measured before, and after PCI.. cTFC (18.38+/-3.30 vs 21.44+/-4.26, P=0.005), in the treatment group was lower than the placebo group, whereas MBG was higher (P=0.04). More patients in the urapidil group achieved significant STR following PCI (93% vs 70%, P=0.04). Left ventricular ejection fraction (LVEF), measured with echocardiography, in the urapidil group was higher than the control group 30 days after PCI (0.58+/-0.06 vs 0.54+/-0.06, P=0.04). Peak CK-MB and peak cTnT in the urapidil group was lower than the control group (P<0.01). Myocardial nitric oxide concentration in the urapidil group was higher than that of the control group (P<0.01). Following PCI, the endothelin-1 level did not change in the urapidil group (P>0.05) but it was increased in the control group (P<0.05).. Urapidil treatment improves coronary flow, myocardial perfusion and left ventricular function following PCI in patients with ST-elevation ACS. These beneficial effects are associated with an enhanced biosynthesis of nitric oxide.

Topics: Acute Coronary Syndrome; Aged; Angioplasty, Balloon, Coronary; Combined Modality Therapy; Coronary Circulation; Echocardiography; Electrocardiography; Endothelin-1; Female; Humans; Male; Middle Aged; Nitric Oxide; Piperazines; Stroke Volume; Vasodilator Agents; Ventricular Function, Left

Successful risk stratification is necessary for optimum management of patients after acute coronary syndrome (ACS). The aim of the study was to evaluate the role of novel biochemical markers in the prediction of adverse cardiovascular events in stable patients several years after ACS.The study group was randomly selected from all ACS patients treated with reperfusion therapy between 2002 and 2003 at 1st Department of Cardiology, Medical University of Warsaw, Poland. All patients were readmitted to hospital between 2010 and 2011 for clinical and biochemical cardiovascular risk factors assessment and were prospectively observed for 30-months follow-up. The primary endpoint was all-cause death or hospital readmissions due to a cardiovascular condition at 30 months. The secondary endpoint was a composite of all-cause death or hospitalization-related noncardiovascular condition during the follow-up.The study population consisted of 146 patients (mean age 66.6 ± 9.8 years; 60 female). The primary and secondary endpoints occurred in 49 and 65 patients, respectively. Univariate analysis demonstrated that out of 17 analyzed biomarkers only high-sensitive C-reactive protein (hsCRP), Soluble Fms-Like Tyrosine kinase-1 (sFlt-1), and endothelin-1 (ET-1) were significantly associated with primary end-point and N-Terminal pro-B-type natriuretic peptide (NT-proBNP), hsCRP, ET-1, sFlt-1, and procalcitonin (PCT)-with secondary end-point. Multivariate analysis demonstrated that concentration of sFlt-1 was the only independent factor associated with primary end-point (P = .007 and P = .025, respectively), whereas NT-proBNP and hsCRP levels were only associated with secondary end-point (P = .004 and P = .001, respectively).sFlt-1, NT-proBNP, and hsCRP are associated with adverse outcomes in stable patients several years after ACS and may emerge as useful clinical biomarkers to enhance stratify patient's risk.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; C-Reactive Protein; Calcitonin; Cause of Death; Endothelin-1; Female; Follow-Up Studies; Humans; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment; Risk Factors; Vascular Endothelial Growth Factor Receptor-1

To examine the effects of depressive symptoms and Endothelin (ET)-1 on 2-year prognosis in younger patients with acute coronary syndrome (ACS). Depression is associated with poor post-ACS prognosis; however, few investigations have focused on younger patients. Importantly, the studies that did emphasize younger patients suggested that the influence of depression on prognosis could be more robust in younger subgroups. The particular links between depression and poor prognosis in younger patients have yet to be definitively determined. ET-1 is a potent endogenous vasoconstrictor that has been previously linked to adverse post-ACS outcomes.. The sample (n=153) included male (age≤50years) and female (age≤55years) ACS patients. Blood samples for ET-1 assessment were collected within 2-3h of ACS hospital admission. Depressive symptoms were assessed with the Beck Depression Inventory (BDI) II within 2-5days of admission. The primary outcome was defined as a composite of major adverse cardiovascular events (MACE), including recurrent myocardial infarction, emergent coronary revascularization, and all-cause mortality within 2years after index admission.. During the follow-up period, 23 patients experienced MACE. Neither the BDI-II score nor ET-1 predicted MACE in unadjusted analyses or in analyses adjusted for demographic characteristics, comorbidities and troponin levels. In the supplementary analyses, feeling depressed in the year preceding ACS predicted MACE.. In this cohort of younger ACS patients, feeling depressed in the year preceding ACS admission predicted MACE in the 2years after baseline ACS event, while neither the BDI-II score, nor circulating ET-1 level predicted this outcome.

Topics: Acute Coronary Syndrome; Adult; Depression; Endothelin-1; Female; Humans; Male; Middle Aged; Prognosis; Time Factors

Acute coronary syndromes (ACS) are complex and polygenic diseases which are a real problem of public health. These syndromes require multidisciplinary studies to understand the pathogenesis mechanisms and metabolic interactions between different risk factors.This study aimed to explore the variation of two coronary risk parameters not mentioned by Framingham cohorts, hyperhomocysteinemia and endothelin-1 (ET-1) in Tunisian coronary and the study of the variation of these parameters based on various cardiac risk factors and metabolic relationship between them.To 157 coronary and 142 healthy subjects, the concentration of homocysteine was quantified by fluorescence polarization immunoassay; the concentration of ET-1 was measured by an analytical technique, the High Performance Liquid Chromatography (HPLC) coupled with mass spectrometry.. Our study showed that homocysteine and ET-1 were significantly higher in patients compared to healthy subjects (24.40 ± 12.5 μmol/L vs 7.44 ± 2.5 μmol/L p <0.00001) for homocysteine and (15.2 ± 5.3 nmol/L vs 7.1 ± 2.7 nmol/L, p <0.00001) for ET-1. On the other hand, homocysteine varies according to tobacco and diabetes while ET-1 depends on the sex, hypertension, smoking, obesity and dyslipidemia and a statistically negative correlation was shown between homocysteine and ET-1 in coronary patients (r = -0.66 p <0.00001).. The study of the variation of these two parameters in coronary patients and metabolic exploration of the relationship between homocysteine and ET-1 according to various risk factors and the interactions between themselves facilitates the decision of therapeutic treatment.

Topics: Acute Coronary Syndrome; Aged; Case-Control Studies; Chromatography, High Pressure Liquid; Endothelin-1; Female; Fluorescence Polarization Immunoassay; Homocysteine; Humans; Hyperhomocysteinemia; Male; Mass Spectrometry; Middle Aged; Prospective Studies; Risk Factors; Sex Factors; Statistics as Topic; Tunisia

We studied relationship between markers of endothelial dysfunction and multifocal atherosclerosis and adverse coronary events in 82 patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Eighteen patients (21.9%) had adverse events during one year of observation. Patients with adverse coronary events had impaired vasodilatory, vasoconstrictive, and adhesive endothelial function. Predictors of unfavorable prognosis in NSTEACS were signs of impaired endothelium-dependent vasodilation during test with reactive hyperemia, high soluble platelet selectin and endothelin-1 levels on day 10 of the disease. Endothelin-1 and soluble platelet-endothelial cell adhesion molecule-1 had greatest predictive power relative to development of non-fatal myocardial infarction.

Topics: Acute Coronary Syndrome; Aged; Biomarkers; Coronary Circulation; Coronary Vessels; Electrocardiography; Endothelin-1; Endothelium, Vascular; Female; Humans; Hyperemia; Male; Middle Aged; Myocardial Infarction; Platelet Endothelial Cell Adhesion Molecule-1; Predictive Value of Tests; Prognosis; Vasoconstriction; Vasodilation

Acute coronary syndromes (ACS) are complex and polygenic diseases which are a real problem of public health. These syndromes require multidisciplinary studies to understand the pathogenesis mechanisms. Our study aims to evaluate the endothelin-1 (ET-1) serum concentration in Tunisian coronary compared to controls healthy, as well as the study of the impact of an intronic polymorphism A (8002) G of pre-pro-endothelin-1 Gene (inactive precursor of ET-1) on the change in serum endothelin-1 and in the susceptibility to Acute coronary syndrome (SCA).. Our samples were subdivided into coronary patients (157) and healthy subjects (142). The quantification of the ET-1 concentration was performed by high performance liquid chromatography, the identification of the different genotypes of the polymorphism A(8002)G was made by PCR-RFLP. The association between the ET-1 concentration and identified genotypes was realized by adapted software for descriptive statistics, Statistical Package for the Sociological Sciences (SPSS v 21.0).. Our study showed that the concentration of ET-1 was significantly higher in patients compared to controls and that the mutated allele prevails in patients F (G) = 0.78 and there is a minority in controls F (G) = 0.3. Secondly the homozygous genotype GG is associated with higher concentrations of ET-1 in patients and controls, heterozygous genotype AG is associated with intermediaries' values and AA genotype is related to lower values.. Although the polymorphism studied is an intronic polymorphism, it is involved in the change in serum concentration of ET-1 and is a candidate gene in susceptibility to SCA. Cardiovascular diseases are "polygenic" pathology and do not obey of the law for transmission of Mendel.

Topics: Acute Coronary Syndrome; Aged; Endothelin-1; Female; Gene Frequency; Genetic Association Studies; Genetic Markers; Genetic Predisposition to Disease; Heterozygote; Homozygote; Humans; Introns; Male; Middle Aged; Phenotype; Polymorphism, Genetic; Retrospective Studies; Risk Assessment; Risk Factors; Tunisia; Up-Regulation

Endothelial dysfunction plays an essential role in the development and progression of atherosclerotic lesions. Endothelial nitric oxide synthase (eNOS) and endothelin-1 (ET-1) are considered important molecules in the endothelial dysfunction process. The aim of the present study was to evaluate the role of eNOS and ET-1 (EDN1) gene polymorphisms as susceptibility markers for acute coronary syndrome (ACS). Six polymorphisms (rs1799983, rs2070744, rs1800783, rs3087459, rs1800541, and rs5369) of eNOS and EDN1 genes were analyzed by 5' exonuclease TaqMan genotyping assays in a group of 452 patients with ACS and 283 healthy controls. The results showed increased frequencies of the A allele of the END1-914 C>A (rs3087459) polymorphism in ACS patients when compared to controls (OR=1.56, Pc=0.01). Under an additive model, the "AA" genotype was associated with an increased risk of developing ACS, adjusted for gender, hypertension, dyslipidemia, alcohol consumption, smoking, and diabetes (OR=1.56, p=0.045). Linkage disequilibrium analysis showed one EDN1 haplotype (AT) with increased frequency in ACS patients when compared to healthy controls (OR=1.65, Pc=0.0015). The "AT" haplotype was associated with the risk of developing ACS after adjusting for cardiovascular risk factors using multiple logistic analysis. In this case, the adjusted OR was 1.73 for the AT haplotype (Pc=0.0018). In summary, resulting data suggest that the END1-914 C>A gene polymorphism could be involved in the risk of developing ACS in Mexican individuals.

Topics: Acute Coronary Syndrome; Aged; Case-Control Studies; Dyslipidemias; Endothelin-1; Female; Gene Frequency; Genetic Predisposition to Disease; Humans; Linkage Disequilibrium; Male; Mexico; Middle Aged; Nitric Oxide Synthase Type III; Polymorphism, Single Nucleotide

To explore the relationship of depressive symptom severity to circulating endothelin (ET)-1 in younger patients with acute coronary syndrome (ACS). Younger patients report greater depressive symptom severity, which predicts poorer post-ACS prognosis. The pathways linking depression to post-ACS prognosis require further elucidation. ET-1 is a potent endogenous vasoconstrictor which has been previously linked to adverse post-ACS outcomes.. The sample (n=153) included males ≤ 50 years of age and females ≤ 55 years of age who participated in a larger study. Blood samples for ET-1 assessment were collected within 2-3h of ACS admission. Depressive symptoms were assessed with the Beck Depression Inventory (BDI) II within 2-5 days of admission. ET-1 was treated as a transformed continuous variable (ET-1T). BDI-II scores were classified into four categories using conventional thresholds demarcating mild, moderate, and severe levels of depressive symptoms. The relationship of classified BDI-II score to ET-1T was examined in simple and multivariable linear regression models.. Classified BDI-II score was related to ET-1T in both unadjusted (χ(2)=9.469, p=0.024) and multivariable (χ(2)=8.430, p=0.038) models, with ET-1T being significantly higher in patients with severe depressive symptoms than in those with mild and moderate depressive symptoms.. In this sample of younger post-ACS patients, severe depressive symptoms were associated with elevated ET-1. We acknowledge that the observed association could be eliminated by the inclusion of some unmeasured variable(s). Longitudinal research should examine whether ET-1 mediates the relationship of depressive symptoms to long-term post-ACS outcomes.

Topics: Acute Coronary Syndrome; Biomarkers; Depression; Endothelin-1; Female; Humans; Linear Models; Male; Middle Aged; Patient Admission; Prognosis; Psychiatric Status Rating Scales; Severity of Illness Index

To examine the relationship of depression severity to circulating endothelin-1 (ET-1), which has previously been linked to plaque rupture and postacute coronary syndrome (ACS) survival. Depression carries an independent two- to four-fold increased risk of early morbidity and mortality after ACS. The pathway(s) linking depression to event-free survival remains to be determined.. Patients with documented history of coronary artery disease (n = 101) provided a resting morning blood sample that was assayed for ET-1, and they completed the Beck Depression Inventory (BDI). ET-1 was treated as a log-transformed continuous variable (logET-1), and as a dichotomous variable using a post-ACS risk threshold previously reported (≥1.16 fmol/mL).. BDI score was related to logET-1 in both unadjusted and adjusted models. In addition, unadjusted and adjusted logistic regression models with dichotomous ET-1 revealed that, for each point increase in BDI score, there was approximately a 14% increased likelihood of being at or above ET-1 risk threshold. Secondary logistic regression models demonstrated a >3.5-fold likelihood of being at or above this risk threshold in association with a BDI score of ≥10.. Depression symptom severity predicts ET-1 elevation that has previously been linked to post-ACS survival, with the greatest risk of elevation among those patients with worse depression symptoms. This link may identify a vulnerability to triggered ACS and poorer survival associated with depression. Future research should establish whether the observed relationship of depressive symptoms to ET-1 level mediates the link between depression and survival.

Topics: Acute Coronary Syndrome; Aged; Depressive Disorder; Endothelin-1; Female; Humans; Logistic Models; Male; Personality Inventory; Prognosis; Risk Factors; Self Report; Severity of Illness Index; Survival Analysis; Tumor Necrosis Factor-alpha

The endothelium plays a role in regulating vascular tone. Acute and dynamic changes in low-flow-mediated constriction (L-FMC) and how it changes with regard to traditional flow-mediated dilatation (FMD) have not been described. We aimed to investigate the changes in brachial artery L-FMC following percutaneous coronary intervention (PCI) and during recovery from non-ST-segment elevation myocardial infarction (NSTEMI).. FMD was performed in accordance with a previously described technique in patients before and after PCI and in the recovery phase of NSTEMI, but in addition, L-FMC data were acquired from the last 30 s of cuff inflation. About 135 scans were performed in 96 participants (10 healthy volunteers and 86 patients). Measurement of brachial L-FMC was reproducible over hours. L-FMC was greater among patients with unstable vs. stable coronary atherosclerosis (-1.33 ±1.09% vs. -0.03 ± 1.26%, P < 0.01). Following PCI, FMD reduced (4.43 ± 2.93% vs. 1.66 ± 2.16%, P < 0.01) and L-FMC increased (-0.33 ± 0.76% vs. -1.63 ± 1.15%, P = 0.02). Furthermore, during convalescence from NSTEMI, L-FMC reduced (-1.37 ± 1.19% vs. 0.01 ± 0.82%, P = 0.02) in parallel with improvements in FMD (2.54 ± 2.19% vs. 5.15 ± 3.07%, P < 0.01).. Brachial L-FMC can be measured reliably. Differences were observed between patients with stable and unstable coronary disease. L-FMC was acutely increased following PCI associated with reduced FMD and, in the recovery from NSTEMI, L-FMC reduced associated with increased FMD. These novel findings characterize acute and subacute variations in brachial L-FMC. The pathophysiological and clinical implications of these observations require further study.

Topics: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Analysis of Variance; Angioplasty, Balloon, Coronary; Biomarkers; Brachial Artery; Cytokines; Endothelin-1; Endothelium, Vascular; Female; Humans; Male; Middle Aged; Myocardial Infarction; Ultrasonography; Vasoconstriction; Vasodilation

We sought to assess whether emotional stress-induced acute coronary syndrome (ACS) is mediated by increased inflammatory and vasoconstrictive mediators.. The World Cup soccer 2006 has been shown to provoke levels of stress sufficient to increase the incidence of ACS. However, the mechanisms by which stress translates into vascular injury up to plaque rupture still remain elusive.. Serum levels of soluble CD40L (sCD40L), soluble vascular cell adhesion molecule (sVCAM)-1, monocyte chemoattractant protein (MCP)-1, tumor necrosis factor (TNF)-alpha, high-sensitivity C-reactive protein (hsCRP), regulated on activation, normal T-cell expressed and secreted (RANTES), and endothelin (ET)-1 were determined in patients who experienced an ACS during World Cup matches, in ACS reference patients (not associated with emotional stress), and in healthy volunteers. Correlations and receiver-operating characteristic curves were calculated to develop multivariable analysis and to investigate the diagnostic value of each parameter.. The sCD40L, sVCAM-1, MCP-1, TNF-alpha, and ET-1 were significantly higher in study patients compared with the reference group. The hsCRP was similar in both groups, whereas RANTES was decreased in study patients. A positive correlation was found between ET-1 and soccer-induced enhanced levels of sCD40L, sVCAM-1, MCP-1, and TNF-alpha. Receiver-operating characteristic analysis displayed high performance of both MCP-1 and ET-1 as a measure to discriminate between stress-induced ACS and ACS controls.. Stress-induced ACS is associated with a profound increase of inflammatory and vasoconstrictive mediators. The evaluation of a targeted drug delivery, such as anti-inflammatory agents, ET-1 receptor antagonists, or inhibition of endothelin-converting enzyme is warranted to reduce stress-mediated cardiovascular morbidity.

Topics: Acute Coronary Syndrome; Anniversaries and Special Events; C-Reactive Protein; Case-Control Studies; CD40 Ligand; Chemokine CCL2; Chemokine CCL5; Endothelin-1; Female; Humans; Male; Middle Aged; Prospective Studies; ROC Curve; Sensitivity and Specificity; Soccer; Stress, Psychological; Tumor Necrosis Factor-alpha; Vascular Cell Adhesion Molecule-1

Topics: Acute Coronary Syndrome; Anniversaries and Special Events; C-Reactive Protein; CD40 Ligand; Chemokine CCL2; Chemokine CCL5; Endothelin-1; Humans; Soccer; Stress, Psychological; Tumor Necrosis Factor-alpha; Vascular Cell Adhesion Molecule-1