Back to Search Start Over

Pregnancy Associated Plasma Protein-A as a Cardiovascular Risk Marker in Patients with Stable Coronary Heart Disease During 10 Years Follow-Up : A CLARICOR Trial Sub-Study

Pregnancy Associated Plasma Protein-A as a Cardiovascular Risk Marker in Patients with Stable Coronary Heart Disease During 10 Years Follow-Up : A CLARICOR Trial Sub-Study

Authors :
Erik Nilsson
Jens Kastrup
Ahmad Sajadieh
Gorm Boje Jensen
Erik Kjøller
Hans Jørn Kolmos
Jonas Wuopio
Christoph Nowak
Anders Larsson
Janus Christian Jakobsen
Per Winkel
Christian Gluud
Kasper K Iversen
Johan Ärnlöv
Axel C. Carlsson
Source :
Nilsson, E, Kastrup, J, Sajadieh, A, Jensen, G B, Kjoller, E, Kolmos, H J, Wuopio, J, Nowak, C, Larsson, A, Jakobsen, J C, Winkel, P, Gluud, C, Iversen, K K, Arnlov, J & Carlsson, A C 2020, ' Pregnancy Associated Plasma Protein-A as a Cardiovascular Risk Marker in Patients with Stable Coronary Heart Disease During 10 Years Follow-Up-A CLARICOR Trial Sub-Study ', Journal of Clinical Medicine, vol. 9, no. 1, 265 . https://doi.org/10.3390/jcm9010265, Journal of Clinical Medicine, Journal of Clinical Medicine, Vol 9, Iss 1, p 265 (2020)
Publication Year :
2020
Publisher :
Uppsala universitet, Klinisk kemi, 2020.

Abstract

Elevated pregnancy-associated plasma protein A (PAPP-A) is associated with mortality in acute coronary syndromes. Few studies have assessed PAPP-A in stable coronary artery disease (CAD) and results are conflicting. We assessed the 10-year prognostic relevance of PAPP-A levels in stable CAD. The CLARICOR trial was a randomized controlled clinical trial including outpatients with stable CAD, randomized to clarithromycin versus placebo. The placebo group constituted our discovery cohort (n = 1.996) and the clarithromycin group the replication cohort (n = 1.975). The composite primary outcome was first occurrence of cardiovascular event or death. In the discovery cohort, incidence rates (IR) for the composite outcome were higher in those with elevated PAPP-A (IR 12.72, 95% Confidence Interval (CI) 11.0−14.7 events/100 years) compared to lower PAPP-A (IR 8.78, 8.25−9.34), with comparable results in the replication cohort. Elevated PAPP-A was associated with increased risk of the composite outcome in both cohorts (discovery Hazard Ratio (HR) 1.45, 95% CI 1.24−1.70; replication HR 1.29, 95% CI 1.10−1.52). In models adjusted for established risk factors, these trends were attenuated. Elevated PAPP-A was associated with higher all-cause mortality in both cohorts. We conclude that elevated PAPP-A levels are associated with increased long-term mortality in stable CAD, but do not improve long-term prediction of death or cardiovascular events when added to established predictors.

Details

Language :
English
Database :
OpenAIRE
Journal :
Nilsson, E, Kastrup, J, Sajadieh, A, Jensen, G B, Kjoller, E, Kolmos, H J, Wuopio, J, Nowak, C, Larsson, A, Jakobsen, J C, Winkel, P, Gluud, C, Iversen, K K, Arnlov, J & Carlsson, A C 2020, ' Pregnancy Associated Plasma Protein-A as a Cardiovascular Risk Marker in Patients with Stable Coronary Heart Disease During 10 Years Follow-Up-A CLARICOR Trial Sub-Study ', Journal of Clinical Medicine, vol. 9, no. 1, 265 . https://doi.org/10.3390/jcm9010265, Journal of Clinical Medicine, Journal of Clinical Medicine, Vol 9, Iss 1, p 265 (2020)
Accession number :
edsair.pmid.dedup....6643d68f9532b61183a52ec7ac9e7326
Full Text :
https://doi.org/10.3390/jcm9010265