Relative value of multiple plasma biomarkers as risk factors for coronary artery disease and death in an angiography cohort.

TitleRelative value of multiple plasma biomarkers as risk factors for coronary artery disease and death in an angiography cohort.
Publication TypeJournal Article
Year of Publication2006
AuthorsLee, KWJ, Hill, JS, Walley, KR, Frohlich, JJ
JournalCMAJ
Volume174
Issue4
Pagination461-6
Date Published2006 Feb 14
ISSN1488-2329
KeywordsAdult, Aged, Biological Markers, Cohort Studies, Coronary Angiography, Coronary Artery Disease, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prognosis, Risk Factors
Abstract

BACKGROUND: Although elevated levels of C-reactive protein (CRP), interleukin (IL)-6, serum amyloid A protein (SAA) and total homocysteine (tHcy) have been associated with the increased likelihood of cardiovascular events, the relative or combined utility of these biomarkers in predicting atherosclerosis and death in an angiography cohort is unknown.METHODS: A cohort of 1117 consecutive patients (797 men and 320 women), referred to 2 Vancouver teaching hospitals for selective coronary angiography, was recruited between 1993 and 1995. Angiography results were obtained for 1019 patients. In 2004 we determined that of 1050 patients who could be traced, 231 had died, 95 of CAD-related causes. We compared the relative utility of baseline measurements of CRP, IL-6, SAA and tHcy as well as of lipids for predicting angiographic CAD and all-cause and CAD-related death.RESULTS: The risk of death increased across quartiles for CRP, IL-6, SAA and tHcy. When comparing the highest and lowest quartiles, the greatest hazard ratios were associated with IL-6 (2.57, 95% confidence interval [CI] 1.62-4.09) and tHcy (2.36, 95% CI 1.53-3.65). A Cox regression model containing all plasma biomarkers and traditional risk factors indicated that age, angiographic CAD and baseline plasma levels of IL-6 and tHcy remained independent predictors of CAD-related death, whereas age, sex, smoking, diabetes and apolipoprotein B levels were independent predictors of angiographic CAD. Kaplan-Meier survival curves indicated a utility in combining measures of CRP, SAA, IL-6 and tHcy for predicting risk of all-cause and CAD-related death.INTERPRETATION: A comparison of elevated levels of CRP, IL-6, SAA and tHcy with traditional CAD risk factors indicated that IL-6 and tHcy were the strongest independent biomarkers for CAD-related death. Elevated levels of multiple biomarkers were associated with an increasing rate of all-cause and CAD-related death.

DOI10.1503/cmaj.050880
Alternate JournalCMAJ
PubMed ID16477056
PubMed Central IDPMC1373750