Role of CD40/ CD40L markers in prognosing cardiovascular events in patients with coronary atherosclerosis

Subclinical inflammation plays an important role in pathogenesis of not only coronary artery disease (CAD) and its acute form, myocardial infarction (MI), but also is a pathophysiological process of glucose metabolism impairment and diabetes mellitus (DM) in particular. Current experimental and clinical trials are focusing on a set of inflammation markers, including sCD40L. Proinflammatory properties of the СD40/СD40L system are due to its ability to increase the synthesis of cell adhesion molecules and various chemokines and to enhance the expression of tissue factor and matrix metalloproteases that cause the instability of an atherosclerotic plaque. These results, together with the data on a high content of CD40L in atherosclerotic plaque, lend support to the view that interaction of CD40L with its receptor might contribute to the instability of atherosclerotic plaque, thus leading to acute complications of atherosclerosis. In recent years, important data on a high prognostic value of sCD40L measurement have been obtained. sCD40L is assumed to be a potential risk indicator for cardiovascular diseases (CVD). It is proved that its level is elevated in patients with myocardial infarction (MI), heart failure and stroke. In addition, high concentrations of sCD40L in blood plasma are also observed in hemodialysis patients. This is found to bear witness to the presence of high risks for fatal and non-fatal cardiovascular events in those patients. However, although sCD40L plays a significant role in CAD prognostication, many questions remain unanswered. There is a need in the development of uniform methods of its measurement. The data that allow considering the given marker as a therapeutic target are few and that requires further studies in the field.