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Cardiovascular disease, commonly manifested as myocardial infarction (MI), is a significant health problem worldwide that in the United States, accounts for one out of every three deaths and remains a significant health problem. Notwithstanding the concerted treatment efforts to target the major pathomechanisms and protect MI patients from ongoing vascular pathology, inflammatory processes have been noted in these cohorts. Results from this multiethnic cohort study by Dr. Szauter and colleagues identified coordinated upregulation of genes for inflammation, T-cell activation, and atherosclerosis and demonstrated that multiple inflammatory pathways, undetected by standard laboratory tests, persist together with immune imbalance and active atherogenesis in medicated MI patients. Data in this Hawaii study population indicated ethnic-specific differences in active inflammatory pathways and highlighted the need for additional ethnicity-based studies to determine specific pathology profiles in particular patient populations for improved treatment modalities that target pathomechanisms unresponsive to current therapies.