Neopterin and kynurenine-tryptophan ratio as predictors of coronary events in older adults, the Hordaland Health Study

Int J Cardiol. 2013 Sep 30;168(2):1435-40. doi: 10.1016/j.ijcard.2012.12.090. Epub 2013 Jan 18.


Background: Immune system activation is involved in atherosclerosis. Neopterin production and tryptophan catabolism through the kynurenine pathway, measured by the kynurenine-tryptophan ratio (KTR), are induced by interferon gamma, thus both are considered markers of cell mediated immune activation. This study prospectively investigated their predictive value on acute coronary events among Norwegian community-dwelling older adults without previous coronary heart disease.

Methods: 1112 men and 1631 women, 71-74 years old were examined during 1997-99 as part of the Hordaland Health Study. They were followed until an acute coronary event (defined as unstable angina, non-fatal or fatal acute myocardial infarction or sudden death) or December 31, 2006. Kaplan-Meier hazard curves were constructed for quartiles of plasma neopterin and KTR. Cox proportional hazards models adjusted for sex, body mass index, smoking, hypertension, renal function and cholesterol were used to examine the relation between neopterin and KTR quartiles and the study endpoint.

Results: Median (interquartile range) values were 8.6 (7.2-10.4) nmol/L for neopterin and 25.8 (25.3-31.1) nmol/μmol for KTR. During the follow up, 265 participants had at least one acute coronary event. Increased baseline levels of plasma neopterin and KTR were associated with continuous increased risk of developing the study endpoint (P-values for trend <0.001 and 0.019, respectively). Adjusted hazard ratios comparing the fourth quartile to the first were 1.65 (95% CI; 1.11-2.47; P=0.013) for neopterin and 1.57 (95% CI 1.03-2.39; P=0.036) for KTR.

Conclusion: Plasma neopterin and KTR levels predict acute coronary events in older adults without previous coronary heart disease.

Keywords: Coronary artery disease; Epidemiology; Immune system; Kynurenine; Neopterin; Tryptophan ratio.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers / blood
  • Coronary Artery Disease / blood*
  • Coronary Artery Disease / diagnosis*
  • Coronary Artery Disease / epidemiology
  • Female
  • Follow-Up Studies
  • Health Surveys* / methods
  • Humans
  • Kynurenine / blood*
  • Male
  • Neopterin / blood*
  • Norway / epidemiology
  • Prospective Studies
  • Tryptophan / blood*


  • Biomarkers
  • Kynurenine
  • Neopterin
  • Tryptophan