Abstract | OBJECTIVES: BACKGROUND: OSEs are immunogenic, proinflammatory, and proatherogenic. The long-term predictive value and net reclassification of OSEs for risk of CVD events are not known. METHODS: RESULTS: Over 15 years of follow-up, 138 subjects reached the primary endpoint of incident CVD ( ischemic stroke, myocardial infarction, new-onset unstable angina, acute coronary interventions, and vascular death). In a multivariable Cox model, the highest tertile of OxPL/ apoB was associated with higher risk of CVD (hazard ratio [HR]: 2.4; 95% confidence interval [CI]: 1.5 to 3.7) and stroke (HR: 3.6; 95% CI: 1.8 to 7.4) compared with the lowest tertile. IgG Cu-OxLDLs were associated with higher risk of CVD, whereas IgM MDA-LDLs were associated with lower risk. Using OxPL/ apoB, IgG Cu- OxLDL, and IgM MDA- LDL variables, the area under the curve (AUC) for CVD risk prediction increased from 0.664 (95% CI: 0.629 to 0.697) to 0.705 (95% CI: 0.672 to 0.737) (p = 0.048). The net reclassification index (NRI) was 0.163 (p = 0.0044) and 0.332 (p < 0.0001) in all subjects (n = 765) and in subjects with intermediate risk (n = 305), respectively. Of 627 subjects who remained free of CVD, 108 were correctly reclassified to a lower risk category, and 83 were reclassified to a higher category (categories: 15-year risk <15%, 15% to 30%, >30%). CONCLUSIONS: OSE biomarkers predict 15-year CVD and stroke outcomes and provide potential clinical utility by reclassifying a significant proportion of individuals into higher or lower risk categories after traditional risk assessment.
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Authors | Sotirios Tsimikas, Peter Willeit, Johann Willeit, Peter Santer, Manuel Mayr, Qingbo Xu, Agnes Mayr, Joseph L Witztum, Stefan Kiechl |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 60
Issue 21
Pg. 2218-29
(Nov 20 2012)
ISSN: 1558-3597 [Electronic] United States |
PMID | 23122790
(Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Biomarkers
- Epitopes
- Phospholipids
|
Topics |
- Aged
- Aged, 80 and over
- Biomarkers
(blood)
- Cardiovascular Diseases
(blood, classification, epidemiology)
- Epitopes
- Female
- Follow-Up Studies
- Forecasting
(methods)
- Humans
- Incidence
- Italy
(epidemiology)
- Male
- Middle Aged
- Oxidation-Reduction
- Phospholipids
(blood)
- Prospective Studies
- Stroke
(blood, classification, epidemiology)
- Survival Rate
(trends)
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