The interleukin-6 −174 G>C promoter polymorphism is associated with a higher risk of death after an acute coronary syndrome in male elderly patients

Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) are key mediators of inflammation and their increased plasma levels are associated with acute coronary syndrome (ACS). Polymorphisms in the promoter region of IL-6 (−174 G>C) and TNF-α (−308 G>A) demonstrated to affect gene expression were analyzed to test their predictive power for cardiovascular death over one year follow-up in elderly male ACS patients. We assessed the IL-6 −174 G>C polymorphism and TNF-α −308 G>A polymorphism in 139 consecutive elderly male patients affected by an ACS, such as ST-Elevation (STEMI), No ST-Elevation (NSTEMI) Myocardial Infarction and Unstable Angina. The presence of well known risk factors for Coronary Heart Diseases (CHD) were also assessed in all ACS patients. Survival rate was assessed after one year follow-up. We found that IL-6 −174 G>C polymorphism is an independent predictor of cardiovascular death after an ACS in male patients. In particular ACS patients carrying the IL-6 −174 C− (GG) genotypes showed a marked increase in one year follow-up mortality rate (HR=3.89, 95% CI 1.71–8.86, p=0.001). Moreover CRP serum levels ≥5.5 mg/dl (HR= 3.79, 95% CI 1.71–8.42, p=0.001), a history of CHD (HR=2.96, 95% CI 1.22–7.20, p=0.016) and the absence of statins treatment (HR=3.27, 95% CI 1.17–9.18, p=0.021), significantly increased one year risk of death in male ACS patients. These data suggest that IL-6 −174 G>C polymorphism can be added to other clinical markers in order to identify a subgroup of elderly ACS male patients at higher risk of death.