Tirandi A, Schiavetta E, Maioli E, Montecucco F, Liberale L. Inflammation as a cause of acute myocardial infarction in patients with myeloproliferative neoplasm. World J Cardiol 2024; 16(2): 58-63 [PMID: 38456066 DOI: 10.4330/wjc.v16.i2.58]
Corresponding Author of This Article
Fabrizio Montecucco, MD, PhD, Full Professor, Department of Internal Medicine University of Genoa, 6 v.le Benedetto XV, Genoa 16132, Italy. fabrizio.montecucco@unige.it
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Amedeo Tirandi, Elisa Schiavetta, Elia Maioli, Fabrizio Montecucco, Luca Liberale, Department of Internal Medicine, University of Genoa, Genoa 16132, Italy
Fabrizio Montecucco, Luca Liberale, IRCCS Ospedale Policlinico San Martino, Genoa – Italian Cardiovascular Network, Genoa 16132, Italy
Author contributions: Tirandi A wrote the paper and drew the image; Schiavetta E, and Maioli E critically revised the paper; Liberale L and Montecucco F supervised the entire work. All the authors read the final version of the manuscript and approve it for the submission and publication.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fabrizio Montecucco, MD, PhD, Full Professor, Department of Internal Medicine University of Genoa, 6 v.le Benedetto XV, Genoa 16132, Italy. fabrizio.montecucco@unige.it
Received: November 22, 2023 Peer-review started: November 22, 2023 First decision: December 23, 2023 Revised: January 1, 2024 Accepted: January 18, 2024 Article in press: January 18, 2024 Published online: February 26, 2024
Abstract
Myeloproliferative neoplasms (MPN) are a group of diseases characterized by the clonal proliferation of hematopoietic progenitor or stem cells. They are clinically classifiable into four main diseases: chronic myeloid leukemia, essential thrombocythemia, polycythemia vera, and primary myelofibrosis. These pathologies are closely related to cardio- and cerebrovascular diseases due to the increased risk of arterial thrombosis, the most common underlying cause of acute myocardial infarction. Recent evidence shows that the classical Virchow triad (hypercoagulability, blood stasis, endothelial injury) might offer an explanation for such association. Indeed, patients with MPN might have a higher number and more reactive circulating platelets and leukocytes, a tendency toward blood stasis because of a high number of circulating red blood cells, endothelial injury or overactivation as a consequence of sustained inflammation caused by the neoplastic clonal cell. These abnormal cancer cells, especially when associated with the JAK2V617F mutation, tend to proliferate and secrete several inflammatory cytokines. This sustains a pro-inflammatory state throughout the body. The direct consequence is the induction of a pro-thrombotic state that acts as a determinant in favoring both venous and arterial thrombus formation. Clinically, MPN patients need to be carefully evaluated to be treated not only with cytoreductive treatments but also with cardiovascular protective strategies.
Core Tip: Myeloproliferative neoplasms (MPNs) are a group of three diseases: essential thrombocythemia, polycythemia vera, and primary myelofibrosis. MPNs have a high risk of acute coronary syndromes due to a pro-thrombotic state. This state is induced by abnormal cancer cells that tend to proliferate and secrete several inflammatory cytokines, sustaining a pro-inflammatory state throughout the body. Clinically, MPN patients need to be carefully evaluated for cytoreductive treatments and cardiovascular protective strategies.
