Plasma Protein Biomarkers and Long‐Term Cardiovascular Mortality Risk in Patients With Chronic Coronary Heart Disease
Background Protein biomarkers that reflect different pathophysiological pathways have been associated with the risk of adverse cardiovascular events. However, it is uncertain whether these associations are sustained with increasing years after the biomarkers are measured. Methods and Results In this...
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Wiley
2024-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.034367 |
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| author | Ralph A. H. Stewart Kristy P. Robledo Andrew M. Tonkin Anthony Keech Leonard Kritharides Ian Marschner Edward Janus Peter L. Thompson Gerald F. Watts Tanja Zeller Harvey D. White John Simes |
| author_facet | Ralph A. H. Stewart Kristy P. Robledo Andrew M. Tonkin Anthony Keech Leonard Kritharides Ian Marschner Edward Janus Peter L. Thompson Gerald F. Watts Tanja Zeller Harvey D. White John Simes |
| author_sort | Ralph A. H. Stewart |
| collection | DOAJ |
| description | Background Protein biomarkers that reflect different pathophysiological pathways have been associated with the risk of adverse cardiovascular events. However, it is uncertain whether these associations are sustained with increasing years after the biomarkers are measured. Methods and Results In this cohort study, 7745 patients with coronary heart disease who participated in the LIPID (Long‐Term Intervention With Pravastatin in Ischemic Disease) trial, BNP (B‐type natriuretic peptide), troponin I, cystatin‐C, C‐reactive protein, d‐dimer and midregional proadrenomedullin were measured at baseline and after 1 year. Discrimination of plasma biomarker concentrations for cardiovascular death were evaluated in landmark analyses from 1 year for the next 5 years of the randomized trial, and for 10 additional years after trial completion. All 6 biomarkers were associated with risk of cardiovascular death (n=1903) both during and after the clinical trial (each P<0.001). C‐statistics for BNP were 0.706 and 0.704; cystatin‐C, 0.686 and 0.693; troponin I, 0.686 and 0.689; C‐reactive protein, 0.655 and 0.684; d‐dimer, 0.670 and 0.679, and midregional adrenomedullin, 0.686 and 0.688, respectively. In multivariable models, adding all 6 biomarkers to models with clinical risk factors increased the C‐statistic for cardiovascular death from 0.709 to 0.775 during the clinical trial, and from 0.713 to 0.751 during 10‐year follow‐up after the randomized trial (P<0.001 for both). Conclusions In patients with chronic coronary heart disease, biomarkers that reflect different pathophysiological pathways are associated with the risk of cardiovascular death for at least the next 15 years. |
| format | Article |
| id | doaj-art-517a94d40daf42009dae9aab721227e4 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-517a94d40daf42009dae9aab721227e42024-11-29T09:50:51ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-11-01132110.1161/JAHA.123.034367Plasma Protein Biomarkers and Long‐Term Cardiovascular Mortality Risk in Patients With Chronic Coronary Heart DiseaseRalph A. H. Stewart0Kristy P. Robledo1Andrew M. Tonkin2Anthony Keech3Leonard Kritharides4Ian Marschner5Edward Janus6Peter L. Thompson7Gerald F. Watts8Tanja Zeller9Harvey D. White10John Simes11Green Lane Cardiovascular Service, Auckland City Hospital, Te Toka Tumai, Te Whatu Ora—Health New Zealand Auckland New ZealandFaculty Medicine and Health, NHMRC Clinical Trials Centre University of Syndey and The Royal Prince Alfred Hospital Camperdown NSW AustraliaSchool of Public Health and Preventive Medicine Monash University Melbourne VIC AustraliaFaculty Medicine and Health, NHMRC Clinical Trials Centre University of Syndey and The Royal Prince Alfred Hospital Camperdown NSW AustraliaDepartment of Cardiology, Concord Hospital The University of Sydney Concord NSW AustraliaFaculty Medicine and Health, NHMRC Clinical Trials Centre University of Syndey and The Royal Prince Alfred Hospital Camperdown NSW AustraliaWestern Health Chronic Disease Alliance and Department of Medicine, Western Health—Melbourne Medical School University of Melbourne Parkville Vic 3010 AustraliaSchool of Population and Global Health The University of Western Australia Perth WA AustraliaMedical School The University of Western Australia Perth WA AustraliaUniversity Heart Centre Hamburg Hamburg GermanyGreen Lane Cardiovascular Service, Auckland City Hospital, Te Toka Tumai, Te Whatu Ora—Health New Zealand Auckland New ZealandFaculty Medicine and Health, NHMRC Clinical Trials Centre University of Syndey and The Royal Prince Alfred Hospital Camperdown NSW AustraliaBackground Protein biomarkers that reflect different pathophysiological pathways have been associated with the risk of adverse cardiovascular events. However, it is uncertain whether these associations are sustained with increasing years after the biomarkers are measured. Methods and Results In this cohort study, 7745 patients with coronary heart disease who participated in the LIPID (Long‐Term Intervention With Pravastatin in Ischemic Disease) trial, BNP (B‐type natriuretic peptide), troponin I, cystatin‐C, C‐reactive protein, d‐dimer and midregional proadrenomedullin were measured at baseline and after 1 year. Discrimination of plasma biomarker concentrations for cardiovascular death were evaluated in landmark analyses from 1 year for the next 5 years of the randomized trial, and for 10 additional years after trial completion. All 6 biomarkers were associated with risk of cardiovascular death (n=1903) both during and after the clinical trial (each P<0.001). C‐statistics for BNP were 0.706 and 0.704; cystatin‐C, 0.686 and 0.693; troponin I, 0.686 and 0.689; C‐reactive protein, 0.655 and 0.684; d‐dimer, 0.670 and 0.679, and midregional adrenomedullin, 0.686 and 0.688, respectively. In multivariable models, adding all 6 biomarkers to models with clinical risk factors increased the C‐statistic for cardiovascular death from 0.709 to 0.775 during the clinical trial, and from 0.713 to 0.751 during 10‐year follow‐up after the randomized trial (P<0.001 for both). Conclusions In patients with chronic coronary heart disease, biomarkers that reflect different pathophysiological pathways are associated with the risk of cardiovascular death for at least the next 15 years.https://www.ahajournals.org/doi/10.1161/JAHA.123.034367biomarkerscardiovascular riskcoronary heart diseasedeathlong‐term survival |
| spellingShingle | Ralph A. H. Stewart Kristy P. Robledo Andrew M. Tonkin Anthony Keech Leonard Kritharides Ian Marschner Edward Janus Peter L. Thompson Gerald F. Watts Tanja Zeller Harvey D. White John Simes Plasma Protein Biomarkers and Long‐Term Cardiovascular Mortality Risk in Patients With Chronic Coronary Heart Disease Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease biomarkers cardiovascular risk coronary heart disease death long‐term survival |
| title | Plasma Protein Biomarkers and Long‐Term Cardiovascular Mortality Risk in Patients With Chronic Coronary Heart Disease |
| title_full | Plasma Protein Biomarkers and Long‐Term Cardiovascular Mortality Risk in Patients With Chronic Coronary Heart Disease |
| title_fullStr | Plasma Protein Biomarkers and Long‐Term Cardiovascular Mortality Risk in Patients With Chronic Coronary Heart Disease |
| title_full_unstemmed | Plasma Protein Biomarkers and Long‐Term Cardiovascular Mortality Risk in Patients With Chronic Coronary Heart Disease |
| title_short | Plasma Protein Biomarkers and Long‐Term Cardiovascular Mortality Risk in Patients With Chronic Coronary Heart Disease |
| title_sort | plasma protein biomarkers and long term cardiovascular mortality risk in patients with chronic coronary heart disease |
| topic | biomarkers cardiovascular risk coronary heart disease death long‐term survival |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.034367 |
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