Comparison of two recent ceramide-based coronary risk prediction scores: CERT and CERT-2

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Leiherer ◽  
A Muendlein ◽  
C.H Saely ◽  
R Laaksonen ◽  
M Laaperi ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Coronary Event ◽  
Cardiovascular Death ◽  
Survival Models ◽  
Risk Category ◽  
Net Reclassification Improvement ◽  
Event Risk ◽  
Risk Predictor ◽  
Risk Categories

Abstract   The Coronary Event Risk Test (CERT) is a validated cardiovascular risk predictor that uses circulating ceramide concentrations to allocate patients into one of four risk categories. This test has recently been updated (CERT-2), now additionally including phosphatidylcholine concentrations. The purpose of this study was to investigate the power of CERT and CERT-2 to predict cardiovascular mortality in patients with cardiovascular disease (CVD). We investigated a cohort of 999 patients with established CVD. Overall, comparing survival curves (figure) for over 12 years of follow up and the predictive power of survival models using net reclassification improvement (NRI), CERT-2 was the best predictor of cardiovascular mortality, surpassing CERT (NRI=0.456; p=0.01) and also the 2019 ESC-SCORE (NRI=0.163; p=0.04). Patients in the highest risk category of CERT as compared to the lowest category had a HR of 3.63 [2.09–6.30] for cardiovascular death; for CERT-2 the corresponding HR was 6.02 [2.47–14.64]. Among patients with T2DM (n=322), the HR for cardiovascular death was 3.00 [1.44–6.23] using CERT and 7.06 [1.64–30.50] using CERT-2; the corresponding HRs among non-diabetic subjects were 2.99 [1.20–7.46] and 3.43 [1.03–11.43], respectively. We conclude that both, CERT and CERT-2 scores are powerful predictors of cardiovascular mortality in CVD patients, especially in those patients with T2D. Performance is even higher with CERT-2. Funding Acknowledgement Type of funding source: None

Abstract 14210: Comparison of Two Recent Ceramide-based Coronary Risk Prediction Scores: CERT and CERT-2

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Andreas Leiherer ◽  
Axel Muendlein ◽  
Christoph H Saely ◽  
Reijo Laaksonen ◽  
Mitja Laaperi ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Coronary Event ◽  
Cardiovascular Death ◽  
Survival Models ◽  
Risk Category ◽  
Net Reclassification Improvement ◽  
Event Risk ◽  
Risk Predictor ◽  
Risk Categories

Introduction: The Coronary Event Risk Test (CERT) is a validated cardiovascular risk predictor that uses circulating ceramide concentrations to allocate patients into one of four risk categories. This test has recently been updated (CERT-2), now additionally including phosphatidylcholine concentrations. Hypothesis: We hypothesize that CERT and CERT-2 have the power to predict cardiovascular mortality in patients with cardiovascular disease (CVD). Methods: We investigated a patient cohort of 999 patients with established CVD. Results: Overall, comparing survival curves (figure) for over 12 years of follow up and the predictive power of survival models using net reclassification improvement (NRI), CERT-2 was the best predictor of cardiovascular mortality, surpassing CERT (NRI=0.456; p=0.01) and also the 2019 ESC-SCORE (NRI=0.163; p=0.04). Patients in the highest risk category of CERT as compared to the lowest category had a HR of 3.63 [2.09-6.30] for cardiovascular death; for CERT-2 the corresponding HR was 6.02 [2.47-14.64]. Among patients with T2DM (n=322), the HR for cardiovascular death was 3.00 [1.44-6.23] using CERT and 7.06 [1.64-30.50] using CERT-2; the corresponding HRs among non-diabetic subjects were 2.99 [1.20-7.46] and 3.43 [1.03-11.43], respectively. Conclusions: We conclude that both, CERT and CERT-2 scores are powerful predictors of cardiovascular mortality in CVD patients, especially in those patients with T2D, performance is even higher with CERT-2.

P4992The ceramide-based Coronary Event Risk Test (CERT) predicts cardiovascular mortality in cardiovascular disease patients with type 2 diabetes mellitus as well as in those without diabetes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Leiherer ◽  
A Muendlein ◽  
C H Saely ◽  
R Laaksonen ◽  
M Laaperi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Hdl Cholesterol ◽  
Coronary Event ◽  
Event Risk ◽  
Risk Predictor

Abstract Background The recently introduced Coronary Event Risk Test (CERT) is a validated cardiovascular risk predictor that uses circulating ceramide concentrations to allocate patients into one of four risk categories. Purpose The purpose of this study was to investigate the power of CERT to predict cardiovascular mortality in patients with established cardiovascular disease (CVD) including patients with type 2 diabetes (T2DM). Methods We investigated a total of 1087 patients with established CVD, including 360 patients with T2DM. At baseline, the prevalence of T2DM increased through CERT categories (29.1, 31.1, 37.4, and 53.4%, respectively, ptrend<0.001). Prospectively, cardiovascular deaths were recorded during a mean follow-up time of 8.1±3.2 years. Results A total of 130 cardiovascular deaths occurred. Overall, cardiovascular mortality increased with increasing CERT categories (figure) and was higher in T2DM patients than in those who did not have diabetes (17.7 vs. 9.4%; p<0.001). In Cox regression models, CERT categories predicted cardiovascular mortality in patients with T2DM (unadjusted HR 1.60 [1.28–2.01]; p<0.001; HR adjusted for age, gender, BMI, smoking, LDL cholesterol, HDL cholesterol, hypertension, and statin use 1.65 [1.27–2.15]; p<0.001) and in those without diabetes (unadjusted HR 1.43 [1.10–1.85]; p=0.008 and adjusted HR 1.41 [1.07–1.85]; p=0.015). Cardiovascular survival of CVD patients Conclusion We conclude that CERT predicts cardiovascular mortality in CVD patients with T2DM as well as in those without diabetes.

scholarly journals The ceramide- and phosphatidylcholine- based Coronary Event Risk Test2 (CERT2) and cardiovascular mortality in men and women with type 2 diabetes

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Leiherer ◽  
A Muendlein ◽  
C H Saely ◽  
B Larcher ◽  
A Mader ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Hdl Cholesterol ◽  
Coronary Event ◽  
Interaction Terms ◽  
Event Risk ◽  
Risk Predictor

Abstract   The recently introduced Coronary Event Risk Test version 2 (CERT2) is a validated cardiovascular risk predictor score that uses circulating ceramide and phosphatidylcholine concentrations. The purpose of this study was to investigate the power of CERT2 to predict cardiovascular mortality in 280 male and 121 female patients with type 2 diabetes (T2DM). Prospectively, we recorded 55 cardiovascular deaths in men and 19 in women during a mean follow-up time of 7.6±3.6 and 8.1±3.4 years respectively. Overall, cardiovascular survival decreased with increasing CERT2 risk categories (figure 1). In Cox regression models, CERT2 significantly predicted the incidence of cardiovascular mortality in male patients with T2DM (unadj. HR 1.82 [1.39–2.37] per standard deviation; p&lt;0.001), the unadj. HR in women was 1.36 [0.83–2.22]; p=0.228). After adjustment for age, BMI, current smoking, LDL cholesterol, HDL cholesterol, hypertension, and statin use the HR in men was 1.73 [1.31–2.29]; p&lt;0.001) and 1.40 [083–2.36]; p=0.210 in women. Interaction terms CERT2 x gender were non-significant both in univariate analysis (p=0.354) and after multivariate adjustment (p=0.359). We conclude that sex does not significantly impact the association of CERT2 with cardiovascular mortality in patients with T2DM. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

scholarly journals The Duke treadmill score with bicycle ergometer: Exercise capacity is the most important predictor of cardiovascular mortality

2018 ◽  
Vol 26 (2) ◽  
pp. 199-207 ◽  
Author(s):  
Esko Salokari ◽  
Jari A Laukkanen ◽  
Terho Lehtimaki ◽  
Sudhir Kurl ◽  
Setor Kunutsor ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Exercise Testing ◽  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Bicycle Exercise ◽  
Metabolic Equivalents ◽  
Ergometer Exercise ◽  
Duke Treadmill Score

Background The Duke treadmill score, a widely used treadmill testing tool, is a weighted index combining exercise time or capacity, maximum ST-segment deviation and exercise-induced angina. No previous studies have investigated whether the Duke treadmill score and its individual components based on bicycle exercise testing predict cardiovascular death. Design Two populations with a standard bicycle testing were used: 3936 patients referred for exercise testing (2371 men, age 56 ± 13 years) from the Finnish Cardiovascular Study (FINCAVAS) and a population-based sample of 2683 men (age 53 ± 5.1 years) from the Kuopio Ischaemic Heart Disease study (KIHD). Methods Cox regression was applied for risk prediction with cardiovascular mortality as the primary endpoint. Results In FINCAVAS, during a median 6.3-year (interquartile range (IQR) 4.5–8.2) follow-up period, 180 patients (4.6%) experienced cardiovascular mortality. In KIHD, 562 patients (21.0%) died from cardiovascular causes during the median follow-up of 24.1 (IQR 18.0–26.2) years. The Duke treadmill score was associated with cardiovascular mortality in both populations (FINCAVAS, adjusted hazard ratio (HR) 3.15 for highest vs. lowest Duke treadmill score tertile, 95% confidence interval (CI) 1.83–5.42, P < 0.001; KIHD, adjusted HR 1.71, 95% CI 1.34–2.18, P < 0.001). However, after progressive adjustment for the Duke treadmill score components, the score was not associated with cardiovascular mortality in either study population, as exercise capacity in metabolic equivalents of task was the dominant harbinger of poor prognosis. Conclusions The Duke treadmill score is associated with cardiovascular mortality among patients who have undergone bicycle exercise testing, but metabolic equivalents of task, a component of the Duke treadmill score, proved to be a superior predictor.

scholarly journals 8-Isoprostanes and Asymmetric Dimethylarginine as Predictors of Mortality in Patients Following Coronary Bypass Surgery: A Long-Term Follow-Up Study

2022 ◽  
Vol 11 (1) ◽  
pp. 246
Author(s):  
Aleksandra Gołąb ◽  
Dariusz Plicner ◽  
Anna Rzucidło-Hymczak ◽  
Lidia Tomkiewicz-Pająk ◽  
Bogusław Gawęda ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Cardiovascular Mortality ◽  
Bypass Surgery ◽  
Asymmetric Dimethylarginine ◽  
Prostaglandin F2α ◽  
Cardiovascular Death ◽  
Long Term Follow Up ◽  
Nitric Oxide Bioavailability

Background: We previously demonstrated that enhanced oxidative stress and reduced nitric oxide bioavailability are associated with unfavorable outcomes early after coronary artery bypass grafting. It is not known whether these processes may impact long-term results. We sought to assess whether during long-term follow-up, markers of oxidative stress and nitric oxide bioavailability may predict cardiovascular mortality following bypass surgery. Methods: We studied 152 consecutive patients (118 men, age 65.2 ± 8.3 years) who underwent elective, primary, isolated on-pump bypass surgery. We measured plasma 8-iso-prostaglandin F2α and asymmetric dimethylarginine before surgery and twice after surgery (18–36 h and 5–7 days). We assessed all-cause and cardiovascular death in relation to these two biomarkers during a mean follow-up time of 11.7 years. Results: The overall mortality was 44.7% (4.7 per 100 patient-years) and cardiovascular mortality was 21.0% (2.2 per 100 patient-years). Baseline 8-iso-prostaglandin F2α was associated with cardiovascular mortality (HR 1 pg/mL 1.010, 95% CI 1.001–1.021, p = 0.036) with the optimal cut-off ≤ 364 pg/mL for higher survival rate (HR 0.460, 95% CI 0.224–0.942, p = 0.030). Asymmetric dimethylarginine > 1.01 μmol/L measured 18–36 h after surgery also predicted cardiovascular death (HR 2.467, 95% CI 1.140–5.340, p = 0.020). Additionally, elevated 8-iso-prostaglandin F2α measured at the same time point associated with all-cause mortality (HR 1 pg/mL 1.007, 95% CI 1.000–1.014, p = 0.048). Conclusions: Our findings indicate that in advanced coronary disease, increased oxidative stress, reflected by 8-iso-prostaglandin F2α before bypass surgery and enhanced asymmetric dimethylarginine accumulation just after the surgery are associated with cardiovascular death during long-term follow-up

scholarly journals MO159CHA2DS2-VASC SCORE AS A PREDICTOR OF CARDIOVASCULAR MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Nina Vodošek Hojs ◽  
Robert Ekart ◽  
Sebastjan Bevc ◽  
Nejc Piko ◽  
Radovan Hojs
Keyword(s):  
Chronic Kidney Disease ◽  
Regression Analysis ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Cardiovascular Mortality ◽  
Cox Regression ◽  
High Sensitivity ◽  
Cardiovascular Death ◽  
Cox Regression Analysis

Abstract Background and Aims Cardiovascular mortality is high in chronic kidney disease (CKD) patients. Recognizing patients with higher cardiovascular risk might help in their treatment. CHA2DS2-VASc score was originally used to predict cerebral infarction in patients with atrial fibrillation (AF). However, it is also useful in predicting outcome in different cardiovascular conditions, independent of the presence of AF. Therefore, the aim of our research was to assess the role of CHA2DS2-VASc score in cardiovascular mortality in CKD patients. Method Eighty-seven non-dialysis CKD patients from our outpatient clinic were included. At the time of inclusion, medical history data and standard blood results were collected and CHA2DS2-VASc score was calculated. Patients were followed for assigned time or until their death. Mean follow-up time was 1696.45±564.60 days. Results Descriptive statistics of our patients are presented in table 1. During follow-up 11 patients suffered from cardiovascular death. Univariate Cox regression analysis showed that CHA2DS2-VASc score is a significant predictor of cardiovascular mortality (HR: 2.19, CI: 1.42-3.37, p=0.001). In multivariate Cox regression analysis in which CHA2DS2-VASc score, serum creatinine, urinary albumin/creatinine, haemoglobin, high sensitivity CRP and intact PTH were included, CHA2DS2-VASc score was an independent predictor of cardiovascular mortality (HR: 2.04, CI: 1.20-3.45, p=0.008) (table 2). Conclusion CHA2DS2-VASc score is a simple and quick way to identify cardiovascular risk in CKD patients.

scholarly journals Impact of Plasma Potassium Normalization on Short‐Term Mortality in Patients With Hypertension and Hyperkalemia

2020 ◽  
Vol 9 (24) ◽  
Author(s):  
Maria Lukács Krogager ◽  
Peter Søgaard ◽  
Christian Torp‐Pedersen ◽  
Henrik Bøggild ◽  
Gunnar Gislason ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Reference Group ◽  
Multivariable Analysis ◽  
Plasma Potassium ◽  
Cardiovascular Death ◽  
Risk Of Death ◽  
Increased Risk ◽  
Short Term Mortality

Background Hyperkalemia can be harmful, but the effect of correcting hyperkalemia is sparsely studied. We used nationwide data to examine hyperkalemia follow‐up in patients with hypertension. Methods and Results We identified 7620 patients with hypertension, who had the first plasma potassium measurement ≥4.7 mmol/L (hyperkalemia) within 100 days of combination antihypertensive therapy initiation. A second potassium was measured 6 to 100 days after the episode of hyperkalemia. All‐cause mortality within 90 days of the second potassium measurement was assessed using Cox regression. Mortality was examined for 8 predefined potassium intervals derived from the second measurement: 2.2 to 2.9 mmol/L (n=37), 3.0 to 3.4 mmol/L (n=184), 3.5 to 3.7 mmol/L (n=325), 3.8 to 4.0 mmol/L (n=791), 4.1 to 4.6 mmol/L (n=3533, reference), 4.7 to 5.0 mmol/L (n=1786), 5.1 to 5.5 mmol/L (n=720), and 5.6 to 7.8 mmol/L (n=244). Ninety‐day mortality in the 8 strata was 37.8%, 21.2%, 14.5%, 9.6%, 6.3%, 6.2%, 10.0%, and 16.4%, respectively. The multivariable analysis showed that patients with concentrations >5.5 mmol/L after an episode of hyperkalemia had increased mortality risk compared with the reference (hazard ratio [HR], 2.27; 95% CI, 1.60–3.20; P <0.001). Potassium intervals 3.5 to 3.7 mmol/L and 3.8 to 4.0 mmol/L were also associated with increased risk of death (HR, 1.71; 95% CI, 1.23–2.37; P <0.001; HR, 1.36; 95% CI, 1.04–1.76; P <0.001, respectively) compared with the reference group. We observed a trend toward increased risk of death within the interval 5.1 to 5.5 mmol/L (HR, 1.29; 95% CI, 0.98–1.69). Potassium concentrations <4.1 mmol/L and >5.0 mmol/L were associated with increased risk of cardiovascular death. Conclusions Overcorrection of hyperkalemia to levels <4.1 mmol/L was frequent and associated with increased all‐cause and cardiovascular mortality. Potassium concentrations >5.5 mmol/L were also associated with an increased all‐cause and cardiovascular mortality.

363-P: The Ceramide- and Phosphatidylcholine-Based Coronary Event Risk Test 2 (CERT2) and Cardiovascular Mortality in Men and Women with Type 2 Diabetes

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 363-P
Author(s):  
ANDREAS LEIHERER ◽  
AXEL MUENDLEIN ◽  
CHRISTOPH H. SAELY ◽  
BARBARA LARCHER ◽  
ARTHUR MADER ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Mortality ◽  
Coronary Event ◽  
Men And Women ◽  
Event Risk

scholarly journals Association between retinopathy and development of long-term cardiovascular events. Results of the follow-up of RETICARD cohort

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
D Aguila Gordo ◽  
M Marina Breysse ◽  
J Piqueras Flores ◽  
M Negreira Caamano ◽  
C Mateo Gomez ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Myocardial Revascularization ◽  
Initial Study ◽  
Hypertensive Retinopathy ◽  
Coronary Syndrome ◽  
Improve Risk Stratification ◽  
Major Cardiovascular Events ◽  
Risk Predictor

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Although the association between retinopathy and cardiovascular disease is known, the usefulness of retinopathy as a risk predictor has not been well studied yet. Methods Prospective study of a cohort of 107 patients with a medical indication for coronary angiography, who underwent a fundus study to assess the presence of retinopathy. The appearance of major cardiovascular events defined by cardiovascular mortality, acute coronary syndrome, cerebrovascular accident, new revascularization, hospital readmission for cardiovascular causes and development of atrial fibrillation (AF) was recorded in a follow-up with a mean of 110, 96 + / -19.74 months. Results The mean age was 75.19 ± 11.53 years. 39.3% were women, 78.5% suffered from hypertension, 32.7% diabetes, and 57% dyslipidaemia. 84.1% had some type of retinopathy at the beginning of follow-up: 0.9% diabetic, 3.7% hypertensive, 1.9% atherosclerotic, and 70.1% hypertensive-atherosclerotic. During the follow-up, all causes mortality was 16.8% and cardiovascular mortality 2.8%. 5.6% of the sample presented an acute ischemic event. 6.5% required new myocardial revascularization. The proportion of patients who developed AF was 11.2%. The readmission rate for all causes 60.7% (cardiovascular cause 28%). Grade ≥ 2 hypertensive retinopathy was associated with a greater need for myocardial revascularization (p = 0.016), being performed earlier than the rest of the patients (108.6 ± 3.9 vs 118.8 ± 0.2 months; p = 0, 01). Atherosclerotic retinopathy was related to a greater development of AF (p = 0.04), appearing in 21.2% of these patients compared to 6.75% in the rest. A greater trend to readmission for cardiovascular causes (p = 0.66) was observed in patients with diabetic retinopathy; 16.13% compared to 5.26% in patients who did not suffer from it. Conclusions The presence of retinopathy, in its different types, is associated with the early development of major cardiovascular events, therefore, the inclusion of the fundus in the initial study of cardiovascular risk may be beneficial to improve risk stratification.

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