scholarly journals Associations between psychosocial burden and prognostic biomarkers in patients with stable coronary heart disease – a STABILITY substudy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Wassberg ◽  
G Batra ◽  
N Hadziosmanovic ◽  
E Hagstrom ◽  
H White ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Troponin T ◽  
Geometric Mean ◽  
Funding Source ◽  
Psychosocial Burden ◽  
Private Company ◽  
Increased Risk ◽  
Stable Coronary Heart Disease ◽  
The Stability

Abstract Background Psychosocial burden is associated with increased risk of cardiovascular (CV) events in patients with stable coronary heart disease (CHD). The underlying mechanisms linking psychosocial burden and CHD are unclear and might be explained by studying biomarkers known to be associated with CV risk. Methods 15,608 patients in the STABILITY trial completed a questionnaire on to what extent they were feeling down, had loss of interest, experienced financial stress and if they were living alone. Levels of high-sensitivity (hs) C-reactive protein (hs-CRP), interleukin-6 (IL-6), hs-troponin T (hs-TnT) and N-terminal pro-B type natriuretic peptide (NT-proBNP) were assessed at baseline. Associations between levels of psychosocial burden (sometimes, often/always vs. never/rarely) and biomarkers were evaluated in a linear model where geometric mean ratio of the log-transformed biomarker were calculated. Results Adjusted associations (age, gender and established CV risk factors) are presented in the table. Conclusion Psychosocial burden in patients with stable CHD was independently associated with elevated biomarkers. The underlying association is likely to be complex and involve multiple pathways. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The STABILITY study was funded by GlaxoSmithKline. Roche Diagnostics, Rotkreuz, Switzerland, supported the research by providing the GDF-15 assay free of charge.

scholarly journals Growth Differentiation Factor 15 Predicts All-Cause Morbidity and Mortality in Stable Coronary Heart Disease

2017 ◽  
Vol 63 (1) ◽  
pp. 325-333 ◽  
Author(s):  
Emil Hagström ◽  
Claes Held ◽  
Ralph A H Stewart ◽  
Philip E Aylward ◽  
Andrzej Budaj ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Troponin T ◽  
High Sensitivity ◽  
Prognostic Biomarkers ◽  
Morbidity And Mortality ◽  
Growth Differentiation Factor 15 ◽  
End Point ◽  
Differentiation Factor ◽  
Stable Coronary Heart Disease

Abstract BACKGROUND Higher growth differentiation factor 15 (GDF-15) concentrations are associated with cardiovascular (CV) and non-CV morbidity and mortality. However, information on associations between GDF-15 and the risk of specific CV and non-CV events in stable coronary heart disease (CHD) patients is limited. METHODS In 14 577 patients with stable CHD participating in the Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy Trial (STABILITY), GDF-15 and other prognostic biomarkers (N-terminal pro–B-type natriuretic peptide, high-sensitivity troponin T, cystatin C, and high-sensitivity C-reactive protein) were measured. In adjusted Cox regression models, the associations between GDF-15 and the composite CV end point [CV death, myocardial infarction (MI), and stroke], as well as other CV and non-CV events, were assessed. RESULTS The median concentration (interquartile range) of GDF-15 at baseline was 1253 (915–1827) ng/L. The hazard ratio for the composite end point for the highest compared to the lowest quartile of GDF-15 was 1.8 (95% CI, 1.5–2.2); for CV death, 2.63 (1.9–3.6); for sudden death, 3.06 (1.9–4.8); for heart failure (HF) death, 4.3 (1.3–14); for cancer death, 2.5 (1.3–4.7); for hospitalization for HF, 5.8 (3.2–10); for MI 1.4 (95% CI, 1.1–1.9); and for stroke, 1.8 (95% CI, 1.1–2.8). After adjustment for other prognostic biomarkers, GDF-15 remained significantly associated with all outcomes except for MI. CONCLUSIONS In stable CHD, GDF-15 was independently associated with CV, non-CV, and cancer mortality, as well as with MI and stroke. When also adjusting for other prognostic biomarkers, the associations to all fatal and nonfatal events were maintained except for MI. Information on GDF-15, therefore, might be helpful when assessing the risk of adverse outcomes in patients with stable CHD. ClinicalTrials.gov Identifier: NCT00799903

scholarly journals Visit-to-visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial

2017 ◽  
Vol 38 (37) ◽  
pp. 2813-2822 ◽  
Author(s):  
Emmanuelle Vidal-Petiot ◽  
Amanda Stebbins ◽  
Karen Chiswell ◽  
Diego Ardissino ◽  
Philip E. Aylward ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Outcomes ◽  
Stable Coronary Heart Disease ◽  
The Stability

P3640Association of ceramide and phospholipid levels and cardiovascular events in stable coronary heart disease: findings from the STABILITY Biomarkers substudy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Laaksonen ◽  
M Hilvo ◽  
D Kauhanen ◽  
T G Lakic ◽  
J Lindback ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cystatin C ◽  
Risk Score ◽  
Cardiovascular Events ◽  
Cardiovascular Outcomes ◽  
Stable Coronary Heart Disease ◽  
Before And After ◽  
The Stability ◽  
Phospholipid Species

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

Post-procedural Troponin T and Creatine kinase-MB elevations influence late outcomes predominantly in patients with stable coronary heart disease

2009 ◽  
Vol 18 ◽  
pp. S225
Author(s):  
Ibrahim Shugman ◽  
Patrick Diu ◽  
Jayesh Gohil ◽  
Krishna Kishor Kadappu ◽  
Melissa Leung ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Creatine Kinase ◽  
Heart Disease ◽  
Troponin T ◽  
Stable Coronary Heart Disease ◽  
Creatine Kinase Mb

Serial measurement of biomarkers and the risk of stroke or systemic embolism and bleeding in patients with atrial fibrillation in ENGAGE AF-TIMI 48

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Oyama ◽  
R Giugliano ◽  
D Berg ◽  
C Ruff ◽  
M Tang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Structural Changes ◽  
Cox Regression ◽  
Troponin T ◽  
Funding Source ◽  
Systemic Embolism ◽  
Private Company ◽  
Chads2 Score ◽  
Increased Risk ◽  
Event Rates

Abstract Background Patients with atrial fibrillation (AF) have progressive cardiac structural changes that may be manifest by biomarkers of myocardial injury and hemodynamic stress. Baseline values of hsTnT (high-sensitivity troponin T), and NT-proBNP (N-terminal pro-brain natriuretic peptide) are associated with stroke risk and GDF-15 (growth differentiation factor-15) is associated with bleeding risk in patients with AF. However, the variability of these biomarkers over time and their associations with stroke or systemic embolism events (S/SEE) and bleeding in patients with AF remain unclear. Purpose We examined whether patients with AF demonstrate detectable changes in these biomarkers over 12 months and whether such changes from baseline to 12 months are associated with the subsequent risk of S/SEE (hsTnT, NT-proBNP) and bleeding (GDF-15). Methods ENGAGE AF-TIMI 48 was a multinational randomized trial of the oral factor Xa inhibitor edoxaban in patients with atrial fibrillation and a CHADS2 score ≥2. We performed a nested prospective biomarker study in 6062 patients, analyzing hsTnT, NT-proBNP, and GDF-15 at baseline and 12 months. Event rates were estimated and displayed with annualized event rates after 12 months. Results Of 6062 patients, hsTnT was dynamic in 46.9% (≥2 ng/L change), NT-proBNP in 51.9% (≥200 pg/L change), GDF-15 in 45.6% (≥300 pg/L change) between baseline and 12 months. In addition, 7.7% in hsTnT shifted from low-&gt;high categories, 9.4% in NT-proBNP from low-&gt;high, 10.6% in GDF-15 from low-&gt;high over 12 months (Figure). Elevated hsTnT (≥14 ng/L) and NT-proBNP (≥900 pg/L) either at baseline or at 12 months were independently associated with higher rates of subsequent S/SEE, and elevated GDF-15 (≥1800 pg/L) either at baseline or at 12 months were independently associated with higher rates of subsequent bleeding (P&lt;0.001 for each). In a Cox regression model, the absolute changes in log2-transformed hsTnT and NT-proBNP were associated with increased risk of S/SEE (adj-HR, 1.75; 95% CI, 1.38–2.23; p&lt;0.001, and adj-HR, 1.31; 95% CI, 1.11–1.55; p=0.002, respectively) and log2-transformed GDF-15 with bleeding (adj-HR, 1.42; 95% CI, 1.04–1.92; p=0.025). Analyzed in a categorical manner (Figure), patients who increased hsTnT or NT-proBNP between baseline and 12 months or had high hsTnT or NT-proBNP at both timepoints were at higher risk for S/SEE (adj-HR 1.87 and 1.50 for hsTnT; adj-HR 1.80 and 2.59 for NT-proBNP, respectively). Patients with persistently elevated GDF-15 appeared to be at higher risk for bleeding (adj-HR,1.35) (Figure). Conclusions Serial assessment of hsTnT, NT-proBNP, and GDF-15 revealed a substantial proportion of patients with AF had dynamic values. Patients with either persistently elevated or dynamic values were at higher risk of adverse clinical outcomes. Those biomarkers may play a role in personalizing preventive strategies in patients with AF based on risk. Change in biomarkers and event rate Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Daiichi Sankyo Pharma Development

scholarly journals Prognostic value of long-term trajectories of depression for incident diabetes mellitus in patients with stable coronary heart disease

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Raphael S. Peter ◽  
Andrea Jaensch ◽  
Ute Mons ◽  
Ben Schöttker ◽  
Roman Schmucker ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Prognostic Value ◽  
Depression Symptom ◽  
Symptoms Of Depression ◽  
Increased Risk ◽  
Stable Coronary Heart Disease ◽  
Symptom Trajectory

Abstract Background Diabetes mellitus (DM) and depression are bidirectionally interrelated. We recently identified long-term trajectories of depression symptom severity in individuals with coronary heart disease (CHD), which were associated with the risk for subsequent cardiovascular events (CVE). We now investigated the prognostic value of these trajectories of symptoms of depression with the risk of incident DM in patients with stable coronary heart disease. Methods The KAROLA cohort included CHD patients participating in an in-patient rehabilitation program (years 1999/2000) and followed for up to 15 years. We included 1048 patients (mean age 59.4 years, 15% female) with information on prevalent DM at baseline and follow-up data. Cox proportional hazards models were used to model the risk for incident DM during follow-up by depression trajectory class adjusted for age, sex, education, smoking status, body mass index, and physical activity. In addition, we modeled the excess risk for subsequent CVE due to incident DM during follow-up for each of the depression trajectories. Results DM was prevalent in 20.7% of patients at baseline. Over follow-up, 296 (28.2%) of patients had a subsequent CVE. During follow-up, 157 (15.0%) patients developed incident DM before experiencing a subsequent CVE. Patients following a high-stable depression symptom trajectory were at substantially higher risk of developing incident DM than patients following a low-stable depression symptom trajectory (hazard ratio (HR) = 2.50; 95% confidence interval (CI) (1.35, 4.65)). A moderate-stable and an increasing depression trajectory were associated with HRs of 1.48 (95%-CI (1.10, 1.98)) and 1.77 (95%-CI (1.00, 3.15)) for incident DM. In addition, patients in the high-stable depression trajectory class who developed incident DM during follow-up were at 6.5-fold risk (HR = 6.51; 95%-CI (2.77, 15.3)) of experiencing a subsequent cardiovascular event. Conclusions In patients with CHD, following a trajectory of high stable symptoms of depression was associated with an increased risk of incident DM. Furthermore, incident DM in these patients was associated with a substantially increased risk of subsequent CVE. Identifying depressive symptoms and pertinent treatment offers might be an important and promising approach to enhance outcomes in patients with CHD, which should be followed up in further research and practice.

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