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Gregersen I, Michelsen AE, Lunde NN, Åkerblom A, Lakic TG, Skjelland M, Ryeng Skagen K, Becker RC, Lindbäck J, Himmelmann A, Solberg R, Johansen HT, James SK, Siegbahn A, Storey RF, Kontny F, Aukrust P, Ueland T, Wallentin L, Halvorsen B. Legumain in Acute Coronary Syndromes: A Substudy of the PLATO (Platelet Inhibition and Patient Outcomes) Trial. J Am Heart Assoc 2020; 9:e016360. [PMID: 32809893 PMCID: PMC7660754 DOI: 10.1161/jaha.120.016360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background The cysteine protease legumain is increased in patients with atherosclerosis, but its causal role in atherogenesis and cardiovascular disease is still unclear. The aim of the study was to investigate the association of legumain with clinical outcome in a large cohort of patients with acute coronary syndrome. Methods and Results Serum levels of legumain were analyzed in 4883 patients with acute coronary syndrome from a substudy of the PLATO (Platelet Inhibition and Patient Outcomes) trial. Levels were analyzed at admission and after 1 month follow-up. Associations between legumain and a composite of cardiovascular death, spontaneous myocardial infarction or stroke, and its individual components were assessed by multivariable Cox regression analyses. At baseline, a 50% increase in legumain level was associated with a hazard ratio (HR) of 1.13 (95% CI, 1.04-1.21), P=0.0018, for the primary composite end point, adjusted for randomized treatment. The association remained significant after adjustment for important clinical and demographic variables (HR, 1.10; 95% CI, 1.02-1.19; P=0.013) but not in the fully adjusted model. Legumain levels at 1 month were not associated with the composite end point but were negatively associated with stroke (HR, 0.62; 95% CI, 0.44-0.88; P=0.0069), including in the fully adjusted model (HR, 0.57; 95% CI, 0.37-0.88; P=0.0114). Conclusions Baseline legumain was associated with the primary outcome in patients with acute coronary syndrome, but not in the fully adjusted model. The association between high levels of legumain at 1 month and decreased occurrence of stroke could be of interest from a mechanistic point of view, illustrating the potential dual role of legumain during atherogenesis and acute coronary syndrome. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00391872.
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Affiliation(s)
- Ida Gregersen
- Research Institute for Internal Medicine Oslo University Hospital Rikshospitalet Oslo Norway.,Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway
| | - Annika E Michelsen
- Research Institute for Internal Medicine Oslo University Hospital Rikshospitalet Oslo Norway.,Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway
| | - Ngoc Nguyen Lunde
- Section of Pharmacology and Pharmaceutical Biosciences Department of Pharmacy University of Oslo Norway
| | - Axel Åkerblom
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Tatevik G Lakic
- Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Mona Skjelland
- Department of Neurology Oslo University Hospital Rikshospitalet Oslo Norway
| | | | - Richard C Becker
- Division of Cardiovascular Health and Disease Heart, Lung and Vascular Institute Academic Health Center Cincinnati OH
| | - Johan Lindbäck
- Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | | | - Rigmor Solberg
- Section of Pharmacology and Pharmaceutical Biosciences Department of Pharmacy University of Oslo Norway
| | - Harald T Johansen
- Section of Pharmacology and Pharmaceutical Biosciences Department of Pharmacy University of Oslo Norway
| | - Stefan K James
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Agneta Siegbahn
- Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease University of Sheffield Sheffield United Kingdom
| | - Frederic Kontny
- Department of Cardiology Stavanger University Hospital Stavanger Norway.,Drammen Heart Center Drammen Norway
| | - Pål Aukrust
- Research Institute for Internal Medicine Oslo University Hospital Rikshospitalet Oslo Norway.,Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway.,Section of Clinical Immunology and Infectious Diseases Oslo University Hospital Rikshospitalet Oslo Norway.,K.G. Jebsen TREC The Faculty of Health Sciences The Arctic University of Tromsø Tromsø Norway
| | - Thor Ueland
- Research Institute for Internal Medicine Oslo University Hospital Rikshospitalet Oslo Norway.,Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway.,K.G. Jebsen TREC The Faculty of Health Sciences The Arctic University of Tromsø Tromsø Norway
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Bente Halvorsen
- Research Institute for Internal Medicine Oslo University Hospital Rikshospitalet Oslo Norway.,Institute of Clinical Medicine Faculty of Medicine University of Oslo Norway
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Åkerblom A, James SK, Lakic TG, Becker RC, Cannon CP, Steg PG, Himmelmann A, Katus HA, Storey RF, Wallentin L, Weaver WD, Siegbahn A. Interleukin-18 in patients with acute coronary syndromes. Clin Cardiol 2019; 42:1202-1209. [PMID: 31596518 PMCID: PMC6906991 DOI: 10.1002/clc.23274] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 01/01/2023] Open
Abstract
Background We aimed to assess associations between circulating IL‐18 concentrations and cardiovascular outcomes in patients with acute coronary syndromes (ACS). Hypothesis and Methods Plasma IL‐18 concentrations were measured at admission, discharge, 1 month, and 6 months in patients with ACS in the PLATelet inhibition and patient Outcomes (PLATO) trial. Associations with outcomes were evaluated with Cox regression models on the composite of CV death, spontaneous myocardial infarction (sMI), or stroke; and on CV death or sMI separately, including adjustment for clinical risk factors and biomarkers (cTnT‐hs, NT‐proBNP, cystatin C, CRP‐hs, and GDF‐15). Results Median IL‐18 concentrations at baseline, discharge, 1 month, and 6 months were 237, 283, 305, and 320 ng/L (n = 16 636). Male sex, obesity, diabetes, and plasma levels of cystatin C, GDF‐15, and CRP‐hs were independently associated with higher IL‐18 levels. Higher baseline IL‐18 levels were associated with the composite endpoint and with CV death (hazard ratio [HR] 1.05, 95% confidence interval [95% CI] 1.02‐1.07 and HR 1.10, 95% CI 1.06‐1.14, respectively, per 25% increase of IL‐18 levels). Associations remained significant after adjustment for clinical variables but became non‐significant after adjustment for all biomarkers (HR 1.01, 95% CI 0.98‐1.04 and HR 1.04, 95% CI 1.00‐1.08, respectively). There were no associations with sMI. Conclusions In ACS patients, IL‐18 concentrations increased after the acute event and remained increased for 6 months. Baseline IL‐18 levels were significantly associated with CV mortality, independent of clinical characteristics and indicators of renal/cardiac dysfunction but this association was attenuated after adjustment for multiple biomarkers.
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Affiliation(s)
- Axel Åkerblom
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Stefan K James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tatevik G Lakic
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Richard C Becker
- Division of Cardiovascular Health and Disease, Heart, Lung, and Vascular Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Philippe G Steg
- Département Hospitalo-Universitaire FIRE, AP-, Paris, France.,Paris Diderot University, Paris, France.,NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK.,FACT (French Alliance for Cardiovascular Trials), an F-CRIN network, Paris, France
| | | | - Hugo A Katus
- Medizinishe Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | - Agneta Siegbahn
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
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Laaksonen R, Hilvo M, Kauhanen D, Lakic TG, Lindback J, Held C, Granger CB, Koenig W, Stewart RAH, White HD, Siegbahn A, Wallentin L. P3640Association of ceramide and phospholipid levels and cardiovascular events in stable coronary heart disease: findings from the STABILITY Biomarkers substudy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Both levels of protein and lipid biomarkers have been found associated with cardiovascular outcomes in patients with stable coronary heart disease (CHD). There are few large-scale studies comparing the prognostic value of and interactions between these two groups of biomarkers in CHD.
Methods
In the 15,828 CHD patients included in the STABILITY trial 10,205 provided plasma samples at baseline allowing measurements of distinct ceramide and phospholipid species by mass spectrometry and markers of cardiac dysfunction (N-terminal pro-B-type natriuretic peptide [NT-proBNP]), high sensitivity cardiac troponin-T [cTnT-hs]), renal dysfunction (cystatin-C), oxidative stress (growth differentiation factor 15 [GDF-15]) by electro-immunoassays. During 3.7 years median follow-up, 1291 CVD, MI, and stroke events occurred. A previously developed ceramide and phospholipid species based risk score (CERT) and its associations to outcomes before and after adjustment were evaluated by Cox-regression models.
Results
The CERT model was significantly associated to all cardiovascular outcomes before and after adjustment for clinical characteristics and routine laboratory tests. However, the associations were attenuated after adjustment for other prognostic biomarkers. The data are summarized in Table 1 below.
Table 1. HR per 1 SD increase in CERT HR (95% CI) p-value MACE Model 1 1.30 (1.24–1.37) <0.0001 Model 2 1.23 (1.16–1.31) <0.0001 Model 3 1.08 (1.02–1.15) 0.0120 CVD Death Model 1 1.57 (1.45–1.69) <0.0001 Model 2 1.38 (1.26–1.50) <0.0001 Model 3 1.14 (1.04–1.26) 0.0052 MACE = CVD death, stroke and MI. Model 1 includes score and randomized treatment. Model 2 includes score, randomized treatment, age, gender, and prior (MI, coronary revas., multivessel CHD), B/L diabetes, hypertension, history of smoking, PVD, region, B/L systolic BP, B/L BMI, HB, WBC, CKD-EPI, LDL-C, HDL-C and TG. Model 3 includes the following covariates in addition to Model 2: TnT-hs, proBNP, Cystatin-C, CRP-hs and IL-6.
Conclusion
A ceramide/phospholipids based risk score is associated with the risk of fatal and non-fatal cardiovascular events in patients with stable CHD. The score is attenuated by adjustment for biomarkers indicating cardiorenal dysfunction and inflammatory activity and may be related to underlying mechanisms for adverse outcomes in stable CHD.
Acknowledgement/Funding
The original STABILITY study was funded by GlaxoSmithKline
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Affiliation(s)
| | - M Hilvo
- Zora Biosciences Oy, Espoo, Finland
| | | | | | | | - C Held
- Uppsala University, Uppsala, Sweden
| | - C B Granger
- Duke University Medical Center, Durham, United States of America
| | - W Koenig
- German Heart Center of Munich, Munich, Germany
| | | | - H D White
- The University of Auckland, Auckland, New Zealand
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Kontny F, Andersen T, Ueland T, Åkerblom A, Lakic TG, Michelsen AE, Aukrust P, Bertilsson M, Becker RC, Himmelmann A, James SK, Siegbahn A, Storey RF, Wallentin L. Pentraxin-3 vs C-reactive protein and other prognostic biomarkers in acute coronary syndrome: A substudy of the Platelet Inhibition and Patients Outcomes (PLATO) trial. Eur Heart J Acute Cardiovasc Care 2019; 9:313-322. [PMID: 31017470 DOI: 10.1177/2048872619846334] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS We investigated the dynamics, associations with patient characteristics, other biomarkers, and clinical outcomes of pentraxin 3 in acute coronary syndrome. METHODS AND RESULTS In multivariate analyses, pentraxin 3 measured in 5154 patients randomised in the Platelet Inhibition and Patients Outcomes (PLATO) trial (NCT00391872) was compared with leukocytes, high-sensitivity C-reactive protein, interleukin-6, cystatin C, N-terminal prohormone brain natriuretic peptide, high-sensitivity troponin T and growth differentiation factor 15 concerning prediction of clinical outcome. Pentraxin 3 peaked earlier than high-sensitivity C-reactive protein and was more strongly correlated with N-terminal prohormone brain natriuretic peptide and high-sensitivity troponin T than with high-sensitivity C-reactive protein. The frequency of cardiovascular death, spontaneous myocardial infarction or stroke by quartiles of pentraxin 3 at admission was 6.1%, 7.3%, 9.7% and 10.7%, respectively (p<0.0001). The hazard ratio per 50% increase of pentraxin 3 was 1.13 (95% confidence interval: 1.07-1.19), p<0.0001. This association remained significant after stepwise adjustments for leukocytes/high-sensitivity C-reactive protein (1.09 (1.02-1.15)), p=0.009, interleukin-6 (1.07 (1.01-1.14)), p=0.026, and cystatin C (1.07 (1.00-1.13)), p=0.044, but not after adjustment for N-terminal prohormone brain natriuretic peptide, high-sensitivity troponin T and growth differentiation factor 15. Admission pentraxin 3 was also associated with several of the individual endpoint components (cardiovascular death/spontaneous myocardial infarction; p=0.008, cardiovascular death; p=0.026, and spontaneous myocardial infarction; p=0.017), but not with stroke. Pentraxin 3 measured in the chronic phase (i.e. at one month) was still predictive of the composite endpoint in univariate analysis (1.12 (1.04-1.20) per 50% increase) p=0.0024, but not after adjustment for the other biomarkers. CONCLUSION Admission level of pentraxin 3 is a modestly stronger predictor than high-sensitivity C-reactive protein and interleukin-6, but not than N-terminal prohormone brain natriuretic peptide or high-sensitivity troponin T, concerning cardiovascular outcome in acute coronary syndrome. Pentraxin 3 is more strongly correlated with N-terminal prohormone brain natriuretic peptide and high-sensitivity troponin T than with high-sensitivity C-reactive protein.
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Affiliation(s)
- Frederic Kontny
- Department of Cardiology, Stavanger University Hospital, Norway.,Drammen Heart Center, Norway
| | - Thomas Andersen
- Department of Anaesthesiology, Stavanger University Hospital, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway.,K.G. Jebsen Thrombosis Research and Expertise Center (TREC), University of Tromsø, Norway
| | - Axel Åkerblom
- Department of Medical Sciences, Cardiology Uppsala University, Sweden.,Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Tatevik G Lakic
- Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Annika E Michelsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway.,K.G. Jebsen Thrombosis Research and Expertise Center (TREC), University of Tromsø, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway.,K.G. Jebsen Thrombosis Research and Expertise Center (TREC), University of Tromsø, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway
| | | | - Richard C Becker
- Division of Cardiovascular Health and Disease, Academic Health Center, Cincinnati, OH, USA
| | | | - Stefan K James
- Department of Medical Sciences, Cardiology Uppsala University, Sweden.,Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Agneta Siegbahn
- Department of Medical Sciences, Cardiology Uppsala University, Sweden.,Department of Medical Sciences, Clinical Chemistry, Uppsala University, Sweden
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, UK
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology Uppsala University, Sweden.,Uppsala Clinical Research Center, Uppsala University, Sweden
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