Vascular endothelial growth factor (VEGF) has been associated with atherosclerosis progression and lesion destabilisation. Despite a beneficial effect of local VEGF administration in myocardial and peripheral ischaemia,¹ recent evidence suggests a pro-atherosclerotic role of VEGF² through its ability to enhance plaque inflammatory infiltration and neovascularisation.

Despite these results, coming mostly from animal studies, there have been few investigations on the relation between VEGF and human coronary artery disease (CAD). These studies yielded conflicting results regarding VEGF concentrations and gene expression in CAD patients compared to controls.^3,4 To elucidate the association of VEGF and CAD further, we performed a prospective study in consecutive patients with chest pain undergoing coronary angiography to compare the coronary status with VEGF plasma concentrations.

MATERIALS AND METHODS

Written informed consent was obtained from 178 patients. Plasma was collected from a femoral artery access immediately before diagnostic coronary angiography. Exclusion criteria were prior myocardial infarction (< 1 month before inclusion), tumour disease, peripheral arterial occlusive disease, ejection fraction < 30%, acute infections, chronic rheumatoid diseases, and chronic obstructive pulmonary disease. Prior statin use was defined as statin treatment for more than 10 days. VEGF plasma concentrations were determined by enzyme linked immunosorbent assay (ELISA, R&D System, Abingdon, UK).

Coronary angiograms were scored visually by a blinded observer: a severity score (0–3) defined the number of vessels with a luminal stenosis ⩾ 50% (for right, left anterior descending, and circumflex …