Low vitamin K status, high sclerostin and mortality risk of stable coronary heart disease patients

Aim: We explored whether matrix Gla protein (MGP, natural calcification inhibitor) and sclerostin (glycoprotein responsible for osteoblast differentiation) interact in terms of mortality risk in coronary patients. Methods: 945 patients after myocardial infarction and/or coronary revascularization were followed in a prospective study. All-cause death, fatal or nonfatal cardiovascular events and heart failure hospitalizations were registered. Results: Either high desphospho-uncarboxylated MGP (dp-ucMGP) or high sclerostin were independently associated with 5-year all-cause/cardiovascular mortality. However, we observed an additional mortality risk in the coincidence of both factors. Concomitantly high dp-ucMGP (≥884 pmol/l) plus sclerostin (≥589 ng/l) were associated with increased all-cause mortality risk compared with ‘normal’ concentration s of both factors (HRR 3.71 [95% CI: 2.07–6.62, p < 0.0001]), or if only one biomarker has been increased. A similar pattern was observed for fatal, but not for nonfatal cardiovascular events. Conclusion: Concomitantly high MGP and sclerostin indicate increased mortality risk, which probably reflects their role in cardiovascular calcifications.

Download Full-text

POS0141 ACTIVE SCREENING FOR GOUT IDENTIFIES A LARGER CARDIOVASCULAR POPULATION AT HIGH MORTALITY RISK

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1872 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 282.2-282

Author(s):

S. Ruiz-Simón ◽

I. Calabuig ◽

M. Gomez-Garberi ◽

M. Andrés

Keyword(s):

High Mortality ◽

Mortality Risk ◽

Cardiovascular Events ◽

Cox Regression ◽

Field Studies ◽

High Mortality Risk ◽

Active Screening ◽

Tertiary Centre ◽

All Cause Mortality

Background:We have recently revealed by active screening that about a third of gout cases in the cardiovascular population is not registered in records [1], highlighting the value of field studies.Objectives:To assess whether gout screening in patients hospitalized for cardiovascular events may also help identify patients at higher risk of mortality after discharge.Methods:A retrospective cohort field study, carried out in 266 patients admitted for cardiovascular events in the Cardiology, Neurology and Vascular Surgery units of a tertiary centre in Spain. The presence of gout was established by records review and face-to-face interview, according to the 2015 ACR/EULAR criteria. The occurrence of mortality during follow-up and its causes were obtained from electronic medical records. The association between gout and subsequent mortality was tested using Cox regression models. Whether covariates affect the gout-associated mortality was also studied.Results:Of 266 patients recruited at baseline, 17 were excluded due to loss to follow-up (>6mo), leaving a final sample of 249 patients (93.6%). Thirty-six cases (14.5% of the sample) were classified as having gout: twenty-three (63.9%) had a previously registered diagnosis, while 13 (36.1%) had not and was established by the interview.After discharge, the mean follow-up was 19.9 months (SD ±8.6), with a mortality incidence of 21.6 deaths per 100 patient-years, 34.2% by cardiovascular causes.Gout significantly increased the risk of subsequent all-cause mortality, with a hazard ratio (HR) of 2.01 (95%CI 1.13 to 3.58). When the analysis was restricted to gout patients with registered diagnosis, the association remained significant (HR 2.89; 95%CI 1.54 to 5.41).The adjusted HR for all-cause mortality associated with gout was 1.86 (95% CI 1.01-3.40). Regarding the causes of death, both cardiovascular and non-cardiovascular were numerically increased.Secondary variables rising the mortality risk in those with gout were age (HR 1.07; 1.01 to 1.13) and coexistent renal disease (HR 4.70; 1.31 to 16.84), while gender, gout characteristics and traditional risk factors showed no impact.Conclusion:Gout was confirmed an independent predictor of subsequent all-cause mortality in patients admitted for cardiovascular events. Active screening for gout allowed identifying a larger population at high mortality risk, which may help tailor optimal management to minimize the cardiovascular impact.References:[1]Calabuig I, et al. Front Med (Lausanne). 2020 Sep 29;7:560.Disclosure of Interests:Silvia Ruiz-Simón: None declared, Irene Calabuig: None declared, Miguel Gomez-Garberi: None declared, Mariano Andrés Speakers bureau: Grunenthal, Menarini, Consultant of: Grunenthal, Grant/research support from: Grunenthal

Download Full-text

Impact of smoking on all-cause mortality and cardiovascular events in patients after coronary revascularization with a percutaneous coronary intervention or coronary artery bypass graft

Coronary Artery Disease ◽

10.1097/mca.0000000000000711 ◽

2019 ◽

Vol 30 (5) ◽

pp. 367-376 ◽

Cited By ~ 6

Author(s):

Wen-Qi Ma ◽

Ying Wang ◽

Xue-Jiao Sun ◽

Xi-Qiong Han ◽

Yi Zhu ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Cardiovascular Events ◽

Coronary Revascularization ◽

Artery Bypass ◽

Bypass Graft ◽

Coronary Intervention ◽

Artery Bypass Graft ◽

Percutaneous Coronary ◽

All Cause Mortality

Download Full-text

The influence of hemoglobin A1c levels on cardiovascular events and all-cause mortality in people with diabetes over 70 years of age. A prospective study

Primary Care Diabetes ◽

10.1016/j.pcd.2020.06.003 ◽

2020 ◽

Vol 14 (6) ◽

pp. 678-684

Author(s):

Domingo Orozco-Beltrán ◽

Jorge Navarro-Pérez ◽

Ana M. Cebrián-Cuenca ◽

Fernando Álvarez-Guisasola ◽

Elena Caride-Miana ◽

...

Keyword(s):

Prospective Study ◽

Cardiovascular Events ◽

Hemoglobin A1c ◽

All Cause Mortality ◽

A Prospective Study

Download Full-text

Calcium, phosphate and the risk of cardiovascular events and all-cause mortality in a population with stable coronary heart disease

Heart ◽

10.1136/heartjnl-2011-300806 ◽

2012 ◽

Vol 98 (12) ◽

pp. 926-933 ◽

Cited By ~ 31

Author(s):

Norma Christine Grandi ◽

Hermann Brenner ◽

Harry Hahmann ◽

Bernd Wüsten ◽

Winfried März ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Calcium Phosphate ◽

Cardiovascular Events ◽

Stable Coronary Heart Disease ◽

All Cause Mortality

Download Full-text

P1252ASSOCIATIONS OF SERUM SCLEROSTIN AND DKK-1 PROTEIN WITH FUTURE CARDIOVASCULAR EVENTS AND MORTALITY IN HEMODIALYSIS PATIENTS; A PROSPECTIVE COHORT STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1252 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

EIRINI STAVRINOU ◽

Panteleimon Sarafidis ◽

Charalampos Loutradis ◽

Evangelos Memmos ◽

Danai Faitatzidou ◽

...

Keyword(s):

Cardiovascular Events ◽

Primary Outcome ◽

Cox Regression ◽

Coronary Revascularization ◽

Prognostic Significance ◽

Decompensated Heart Failure ◽

Hemodialysis Patients ◽

High Serum ◽

All Cause Mortality ◽

Cardiovascular Endpoint

Abstract Background and Aims Sclerostin and Dickkopf-1 (Dkk-1) protein are inhibitors of the canonical Wnt/β-catenin bone pathway. Sclerostin but not Dkk-1 is associated with increased arterial stiffness. This study examined the prognostic significance of serum sclerostin and Dickkopf-related protein-1 (Dkk-1) levels for cardiovascular outcomes and mortality in hemodialysis patients. Method Serum sclerostin and Dkk-1 levels were measured with ELISA in 80 hemodialysis patients that were followed-up for a median of 45 months. Several factors that could interfere in the association of sclerostin and Dkk-1 with outcomes (including carotid-femoral pulse-wave-velocity (PWV), parathyroid hormone, calcium-phospate product and others) were assessed at baseline The primary end-point was a combination of all-cause death, non-fatal myocardial infarction, non-fatal stroke, coronary revascularization, hospitalization for decompensated heart failure and new-onset atrial fibrillation. Secondary end-points included cardiovascular and all-cause mortality. Results Cumulative freedom from the primary endpoint was significantly lower for higher tertiles of sclerostin (77.8%, 69.2%, and 40.7% for tertiles 1 to 3 respectively; log-rank-p=0.004). The corresponding risk for the primary outcome was gradually increasing for higher tertiles of sclerostin (Tertile 3: HR: 3.847, 95%CI: 1.502-9.851). No significant association was evident between sclerostin and all-cause mortality, whereas higher sclerostin levels presented a trend towards higher risk for cardiovascular mortality. Dkk-1 levels exhibited no association with the risk of the primary or the secondary endpoints. In stepwise Cox regression modeled analysis, sclerostin levels were associated with the primary outcome, independently of PTH, calcium-phosphate product, serum albumin, CRP and PWV levels (HR: 2.921, 95%CI: 1.401–6.090; p=0.004). Conclusion High serum sclerostin levels are associated with lower cumulative freedom and higher risk for a composite cardiovascular endpoint but not for all-cause mortality. Dkk-1 protein exhibited no association with the future risk of cardiovascular events.

Download Full-text

Response to ‘calcium, phosphate and the risk of cardiovascular events and all-cause mortality in a population with stable coronary heart disease’

Heart ◽

10.1136/heartjnl-2012-302480 ◽

2012 ◽

Vol 99 (5) ◽

pp. 349.1-350

Author(s):

Mark David Lucock ◽

Charlotte Martin ◽

Lyndell Boyd ◽

Nenad Naumovski ◽

Paul Roach ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Calcium Phosphate ◽

Cardiovascular Events ◽

Stable Coronary Heart Disease ◽

All Cause Mortality

Download Full-text

Hyperarousal Symptoms in Survivors of Cardiac Arrest Are Associated With 13 Month Risk of Major Adverse Cardiovascular Events and All-Cause Mortality

Annals of Behavioral Medicine ◽

10.1093/abm/kaz058 ◽

2020 ◽

Vol 54 (6) ◽

pp. 413-422

Author(s):

Alex Presciutti ◽

Jonathan Shaffer ◽

Jennifer A Sumner ◽

Mitchell S V Elkind ◽

David J Roh ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiovascular Events ◽

Coronary Revascularization ◽

Cox Proportional Hazards ◽

Survival Models ◽

Major Adverse Cardiovascular Events ◽

Ptsd Symptoms ◽

Standard Deviation Increase ◽

Increased Risk ◽

All Cause Mortality

Abstract Background Key dimensions of cardiac arrest-induced posttraumatic stress disorder (PTSD) symptoms include reexperiencing, avoidance, numbing, and hyperarousal. It remains unknown which dimensions are most predictive of outcome. Purpose To determine which dimensions of cardiac arrest-induced PTSD are predictive of clinical outcome within 13 months posthospital discharge. Methods PTSD symptoms were assessed in survivors of cardiac arrest who were able to complete psychological screening measures at hospital discharge via the PTSD Checklist-Specific scale, which queries for 17 symptoms using five levels of severity. Responses on items for each symptom dimension of the four-factor numbing model (reexperiencing, avoidance, numbing, and hyperarousal) were converted to Z-scores and treated as continuous predictors. The combined primary endpoint was all-cause mortality (ACM) or major adverse cardiovascular events (MACE; hospitalization for myocardial infarction, unstable angina, heart failure, emergency coronary revascularization, or urgent defibrillator/pacemaker placements) within 13 months postdischarge. Four bivariate Cox proportional hazards survival models evaluated associations between individual symptom dimensions and ACM/MACE. A multivariable model then evaluated whether significant bivariate predictors remained independent predictors of the primary outcome after adjusting for age, sex, comorbidities, premorbid psychiatric diagnoses, and initial cardiac rhythm. Results A total of 114 patients (59.6% men, 52.6% white, mean age: 54.6 ± 13 years) were included. In bivariate analyses, only hyperarousal was significantly associated with ACM/MACE. In a fully adjusted model, 1 standard deviation increase in hyperarousal symptoms corresponded to a two-times increased risk of experiencing ACM/MACE. Conclusions Greater level of hyperarousal symptoms was associated with a higher risk of ACM/MACE within 13 months postcardiac arrest. This initial evidence should be further investigated in a larger sample.

Download Full-text