Title: Preliminary Results Indicate Carotid Intima-Media Thickness Is Biomarker of Atherosclerosis: Presented at DALM
"Preliminary Results Indicate Carotid Intima-Media Thickness Is Biomarker of Atherosclerosis: Presented at DALM"By Crina Frincu-Mallos, PhD NEW YORK, NY -- October 12, 2007 -- Overall data from the IMPROVE trial support the concept that carotid intima-media thickness (IMT) and IMT progression constitute novel biomarkers of atherosclerotic disease, according to a study presented here on at the XVI International Symposium on Drugs Affecting Lipid Metabolism (DALM).
Elena Tremoli, MD, Professor and Director, Department of Pharmacological Sciences, University of Milan, and Research Coordinator, Centro Cardiologico Monzino, IRCCS, Milan, Italy, presented the data on October 6.
The Carotid IMT and IMT-PROgression as Predictors of Vascular Events in a High Risk European Population (IMPROVE) study is an ongoing prospective, multicentre, longitudinal study with 3,711 patients from six European countries. All patients were classified as being at high risk for cardiovascular disease with at least three vascular risk factors, said Dr. Tremoli.
Patient enrollment ended in April 2005; patients were recruited from Finland (n=1,050), Sweden (n=533), The Netherlands (n=532), France (n=501), and Italy (n=1,095).
This patient population consists of men and women in approximately a 1:1 ratio (aged 64 +- 5 years). The largest percentage of patients have familial hypercholesterolaemia (78.6%); 23.9% of patients have diabetes.
The study is designed to determine whether it is feasible to predict new vascular events based on the progression of carotid IMT, "alone or after integration with conventional and nonconventional risk factors," explained Dr. Tremoli. IMT, a novel surrogate marker of atherosclerosis, is measured by high-resolution B-mode ultrasound.
Preliminary results indicate a significant connection between high sensitivity C-reactive protein (hs-CRP) and gender in the overall population. "Hs-CRP is a determinant of carotid IMT in men only," said Dr. Tremoli. However, cigarette smoking unmasks the association between hs-CRP and carotid IMT in women, she added.
The study monitored the occurrence of cardiovascular events over a period of 36 months.
A total of 135 first events occurred in the 3,393 patients enrolled in the trial, the most common event being angina pectoris (n=45), angioplasty/stent (n=39), stroke (n=21), and coronary bypass (n=16).
In addition, the researchers observed a geographic (North-South) gradient in carotid IMT when they analysed the baseline data.
The preliminary data support the concept that carotid IMT is a biomarker of atherosclerotic disease, concluded Dr. Tremoli. Data on the predictive capacity of carotid IMT-progression should be available by the end of next year.
Funding for this study was provided by the Italian Ministry of Health, European Commission, and the IMPROVE project.
Presentation title: Carotid Intima Media Thickness as Marker of Atherosclerosis: Results of the IMPROVE Study. Abstract 159.
Showing posts with label Biomarkers. Show all posts
Showing posts with label Biomarkers. Show all posts
Sunday, October 14, 2007
Thursday, August 9, 2007
New Biomarker for Heart Failure
International Research Team Advances Understanding Of Heart Failure
Article URL: http://www.medicalnewstoday.com/articles/78988.php
09 Aug 2007
A potential new biomarker for heart failure may be more powerful than established measures in identifying patients at increased risk for death from several causes. In a report to appear in the Journal of the American College of Cardiology that has received early online release, an international research team describes finding that blood levels of a protein called ST2 both indicate the presence of heart failure among patients with shortness of breath and powerfully predict the risk that a patient will die during the following year. Improved understanding of how ST2 and other biomarkers reflect aspects of the heart's hormonal environment someday may allow clinicians to develop more effective, individualized treatment plans.
"While we are now able to diagnose heart failure with great sensitivity using natriuretic peptide tests, we have miles to go before we can reduce the considerable risk that accompanies that diagnosis," says James Januzzi Jr., MD, of the MGH Cardiology Division, who led the study. "It's highly likely that examining a patient's pattern of several complementary biomarkers will be superior for predicting risk than using just one. If we could harness the information these biomarkers yield to better adjust therapies -- in the same way that antibiotics are chosen based on the organism causing the infection -- that would be revolutionary."
A condition in which the heart muscle is damaged and cannot pump blood efficiently, heart failure is a major cause of cardiac death. Diagnosis has been a challenge, since the symptoms of heart failure are similar to those of many other conditions. In recent years studies from several groups, including collaborators on the current report, have identified a number of candidate biomarkers for diagnosis. In 2005, Januzzi and colleagues from the MGH published the PRIDE study, which showed that a protein called NT-proBNP, one of the natriuretic peptides, could confirm or rule out a diagnosis of heart failure in emergency room patients with shortness of breath. In addition NT-proBNP strongly predicted death among such patients.
Recent smaller studies have suggested that ST2, which appears to have a role in the inflammatory response, also may be expressed within the heart in situations involving stress to the cardiac muscle, including heart failure. To more closely examine ST2's potential as a heart failure biomarker, the research team analyzed data and blood samples from the PRIDE study participants, almost 600 individuals who had come to the MGH Emergency Department with shortness of breath.
In this study, the single largest ST2 analysis to date, the researchers confirmed ST2 as a novel marker of heart failure, finding the highest levels among participants with the disorder. More striking, elevated ST2 levels strongly predicted the risk of death during the year after the initial hospital visit, even among patients who did not have heart failure. In fact, ST2 appeared to be a stronger predictor of death than was NT-proBNP, and a combination of both biomarkers gave the most accurate prediction for all study participants
"We have confirmed the potential importance of ST2 to predict risk. What we don't have now is information on how ST2 changes after adequate heart failure treatment and what that tells us about patients' response to therapy," Januzzi says. "It's likely that patterns of multiple biomarkers will help us identify patients with heart failure who remain at a high risk for death, even though they appear to be symptomatically improving during treatment. There are studies underway here at MGH and elsewhere investigating whether such biomarker 'fingerprints' can guide specific treatment strategies for heart failure and other cardiovascular diseases." Januzzi is an associate professor of Medicine at Harvard Medical School and director of the Cardiac Intensive Care Unit at MGH.
Source: Massachusetts General Hospital
Article URL: http://www.medicalnewstoday.com/articles/78988.php
09 Aug 2007
A potential new biomarker for heart failure may be more powerful than established measures in identifying patients at increased risk for death from several causes. In a report to appear in the Journal of the American College of Cardiology that has received early online release, an international research team describes finding that blood levels of a protein called ST2 both indicate the presence of heart failure among patients with shortness of breath and powerfully predict the risk that a patient will die during the following year. Improved understanding of how ST2 and other biomarkers reflect aspects of the heart's hormonal environment someday may allow clinicians to develop more effective, individualized treatment plans.
"While we are now able to diagnose heart failure with great sensitivity using natriuretic peptide tests, we have miles to go before we can reduce the considerable risk that accompanies that diagnosis," says James Januzzi Jr., MD, of the MGH Cardiology Division, who led the study. "It's highly likely that examining a patient's pattern of several complementary biomarkers will be superior for predicting risk than using just one. If we could harness the information these biomarkers yield to better adjust therapies -- in the same way that antibiotics are chosen based on the organism causing the infection -- that would be revolutionary."
A condition in which the heart muscle is damaged and cannot pump blood efficiently, heart failure is a major cause of cardiac death. Diagnosis has been a challenge, since the symptoms of heart failure are similar to those of many other conditions. In recent years studies from several groups, including collaborators on the current report, have identified a number of candidate biomarkers for diagnosis. In 2005, Januzzi and colleagues from the MGH published the PRIDE study, which showed that a protein called NT-proBNP, one of the natriuretic peptides, could confirm or rule out a diagnosis of heart failure in emergency room patients with shortness of breath. In addition NT-proBNP strongly predicted death among such patients.
Recent smaller studies have suggested that ST2, which appears to have a role in the inflammatory response, also may be expressed within the heart in situations involving stress to the cardiac muscle, including heart failure. To more closely examine ST2's potential as a heart failure biomarker, the research team analyzed data and blood samples from the PRIDE study participants, almost 600 individuals who had come to the MGH Emergency Department with shortness of breath.
In this study, the single largest ST2 analysis to date, the researchers confirmed ST2 as a novel marker of heart failure, finding the highest levels among participants with the disorder. More striking, elevated ST2 levels strongly predicted the risk of death during the year after the initial hospital visit, even among patients who did not have heart failure. In fact, ST2 appeared to be a stronger predictor of death than was NT-proBNP, and a combination of both biomarkers gave the most accurate prediction for all study participants
"We have confirmed the potential importance of ST2 to predict risk. What we don't have now is information on how ST2 changes after adequate heart failure treatment and what that tells us about patients' response to therapy," Januzzi says. "It's likely that patterns of multiple biomarkers will help us identify patients with heart failure who remain at a high risk for death, even though they appear to be symptomatically improving during treatment. There are studies underway here at MGH and elsewhere investigating whether such biomarker 'fingerprints' can guide specific treatment strategies for heart failure and other cardiovascular diseases." Januzzi is an associate professor of Medicine at Harvard Medical School and director of the Cardiac Intensive Care Unit at MGH.
Source: Massachusetts General Hospital
Tuesday, July 3, 2007
Myeloperoxidase (MPO): New Marker for Heart Disease and stroke
Molecule Signals Heart Disease in Early StagesStudy found high levels of protein predicted development of cardiovascular trouble
HealthDay
MONDAY, July 2 (HealthDay News) -- A molecule that could be a powerful new marker for heart disease and stroke has passed its first real-world test, researchers report.
In an eight-year study, high blood levels of myeloperoxidase (MPO) were closely associated with the early development of heart disease, and its predictive abilities were independent of classic risk factors such as high cholesterol, high blood pressure and diabetes. The finding is detailed in the July 10 issue of the Journal of the American College of Cardiology.
"This is the first time this particular marker has been looked at in an apparently healthy population," said Dr. Stanley L. Hazen, head of the section of preventive cardiology and cardiac rehabilitation at the Cleveland Clinic. His group has been working on MPO for more than a decade.
Hazen has filed for patents on MPO as a biomarker for cardiovascular disease. MPO tests now are available commercially and "at least five pharmaceutical companies are working to develop inhibitors of MPO," Hazen said.
MPO is a protein secreted by white blood cells. It signals inflammation and releases a bleach-like substance that damages the cardiovascular system. "Over a decade ago, our group showed that it is involved in tissue damage," Hazen said. "There are very large research and genetic studies that link MPO to the development of heart disease."
The new report describes use of MPO levels as a screening tool in a healthy population living in Norfolk, England. MPO readings were taken from thousands of residents at the start of the study. Eight years later, the researchers compared those readings in the 1,138 people who had developed coronary artery disease and 2,237 people, matched for age and sex, who had not.
The incidence of heart disease was 49 percent higher in people ranked among the top 25 percent of MPO levels, compared to those in the lowest quarter. Their risk was 36 percent higher when traditional risk factors including cholesterol levels, high blood pressure, smoking and diabetes were taken into account.
"Even if your other biomarkers were normal, if MPO levels were high, you were at higher risk," Hazen said. "The magnitude of the risk is roughly comparable to the risk of elevated LDL cholesterol."
LDL cholesterol collects in fatty plaques that eventually block arteries. It is a major target of medications aimed at reducing risk of heart attack and stroke, most notably statins.
The first commercially available test for MPO levels was approved by the U.S. Food and Drug Administration a year ago, Hazen said. "Its first intended use is for evaluating people with a history of chest pain, people who go to the emergency room or cardiologist," he said. His hope is that it eventually will become a standard screening tool.
"We believe it is potentially of utility for people who you don't know may be at risk," he said.
A high MPO reading now indicates that the physician should concentrate on reducing known risk factors, but MPO itself could eventually become a target of drug treatment, he said.
"One fascinating aspect of this study is that this marker of inflammation precedes by nearly a decade the development of clinical coronary disease," Dr. Christopher Cannon, an associate professor of medicine at Harvard Medical School, said in a statement. "This suggests MPO could be used to catch the disease in a very early stage and help in true prevention of coronary artery disease."
MPO might also be a marker for unstable plaque, deposits that can erupt to emit artery-blocking fragments, Cannon added. "More study is needed, but among hundreds of markers tested to date, MPO looks like a keeper that will one day become part of clinical care," he said.
More information
The known risk factors for cardiovascular disease are described by the American Heart Association.
SOURCES: Stanley L. Hazen, M.D., director, section of preventive cardiology and cardiac rehabilitation, Cleveland Clinic; Christopher Cannon, M.D., associate professor, medicine, Harvard Medical School, Boston; July 10, 2007, Journal of the American College of Cardiology
HealthDay
MONDAY, July 2 (HealthDay News) -- A molecule that could be a powerful new marker for heart disease and stroke has passed its first real-world test, researchers report.
In an eight-year study, high blood levels of myeloperoxidase (MPO) were closely associated with the early development of heart disease, and its predictive abilities were independent of classic risk factors such as high cholesterol, high blood pressure and diabetes. The finding is detailed in the July 10 issue of the Journal of the American College of Cardiology.
"This is the first time this particular marker has been looked at in an apparently healthy population," said Dr. Stanley L. Hazen, head of the section of preventive cardiology and cardiac rehabilitation at the Cleveland Clinic. His group has been working on MPO for more than a decade.
Hazen has filed for patents on MPO as a biomarker for cardiovascular disease. MPO tests now are available commercially and "at least five pharmaceutical companies are working to develop inhibitors of MPO," Hazen said.
MPO is a protein secreted by white blood cells. It signals inflammation and releases a bleach-like substance that damages the cardiovascular system. "Over a decade ago, our group showed that it is involved in tissue damage," Hazen said. "There are very large research and genetic studies that link MPO to the development of heart disease."
The new report describes use of MPO levels as a screening tool in a healthy population living in Norfolk, England. MPO readings were taken from thousands of residents at the start of the study. Eight years later, the researchers compared those readings in the 1,138 people who had developed coronary artery disease and 2,237 people, matched for age and sex, who had not.
The incidence of heart disease was 49 percent higher in people ranked among the top 25 percent of MPO levels, compared to those in the lowest quarter. Their risk was 36 percent higher when traditional risk factors including cholesterol levels, high blood pressure, smoking and diabetes were taken into account.
"Even if your other biomarkers were normal, if MPO levels were high, you were at higher risk," Hazen said. "The magnitude of the risk is roughly comparable to the risk of elevated LDL cholesterol."
LDL cholesterol collects in fatty plaques that eventually block arteries. It is a major target of medications aimed at reducing risk of heart attack and stroke, most notably statins.
The first commercially available test for MPO levels was approved by the U.S. Food and Drug Administration a year ago, Hazen said. "Its first intended use is for evaluating people with a history of chest pain, people who go to the emergency room or cardiologist," he said. His hope is that it eventually will become a standard screening tool.
"We believe it is potentially of utility for people who you don't know may be at risk," he said.
A high MPO reading now indicates that the physician should concentrate on reducing known risk factors, but MPO itself could eventually become a target of drug treatment, he said.
"One fascinating aspect of this study is that this marker of inflammation precedes by nearly a decade the development of clinical coronary disease," Dr. Christopher Cannon, an associate professor of medicine at Harvard Medical School, said in a statement. "This suggests MPO could be used to catch the disease in a very early stage and help in true prevention of coronary artery disease."
MPO might also be a marker for unstable plaque, deposits that can erupt to emit artery-blocking fragments, Cannon added. "More study is needed, but among hundreds of markers tested to date, MPO looks like a keeper that will one day become part of clinical care," he said.
More information
The known risk factors for cardiovascular disease are described by the American Heart Association.
SOURCES: Stanley L. Hazen, M.D., director, section of preventive cardiology and cardiac rehabilitation, Cleveland Clinic; Christopher Cannon, M.D., associate professor, medicine, Harvard Medical School, Boston; July 10, 2007, Journal of the American College of Cardiology
Tuesday, June 5, 2007
Men With Inflammatory Marker Have Three Times Higher Risk Of Heart Disease
Men With Inflammatory Marker Have Three Times Higher Risk Of Heart Disease
05 Jun 2007
Men whose blood tests positive for the auto-antibody rheumatoid factor have a three times higher risk of heart disease, according to a study published online ahead of print in Heart .
This increased risk was similar to that found for the well-known risk factors of diabetes (2.5 times) and high blood pressure (4.4 times). However, rheumatoid factor was not found to increase the risk of heart disease in women.
The findings add more weight to the growing evidence that inflammation is implicated in atherosclerosis - a hardening of the arteries, when fats are deposited in the artery walls. It also raises the possibility that auto-immune processes and rheumatoid factor in particular may actually have a role in the disease process itself.
This build up of fatty deposits reduces blood supply to the heart (known as ischaemic heart disease) leading to angina and an increased risk of heart attack.
Rheumatoid factor is an auto-antibody present in up to 15% of adults and is strongly associated with rheumatoid arthritis. Chronic inflammatory diseases, such as rheumatoid arthritis, have been shown previously to increase the risk of ischaemic heart disease. However, the prevalence of rheumatoid arthritis in men in the UK is only about 0.4 per cent, so rheumatoid factor therefore seems to be an independent risk factor in men. Rheumatoid factor can be measured by a simple blood test available in all hospitals.
The study involved 567 men and 589 women born in Hertfordshire between 1931 and 1937 who were assessed for a history of ischaemic heart disease, rheumatoid factor and traditional risk factors for heart disease. They were also assessed for other common auto-antibodies (antinuclear antibodies and anticardiolipin antibodies), but no link to increased risk of ischaemic heart disease was found.
Another inflammatory marker C-reactive protein has also been linked to the development of ischaemic heart disease in previous studies.
The autoantibody rheumatoid factor may be an independent risk factor for ischaemic heart disease in men
Online First Heart 2007;0:1-5. doi: 10.1136/hrt.2006.097816
www.heart.bmj.com
Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=73015
05 Jun 2007
Men whose blood tests positive for the auto-antibody rheumatoid factor have a three times higher risk of heart disease, according to a study published online ahead of print in Heart .
This increased risk was similar to that found for the well-known risk factors of diabetes (2.5 times) and high blood pressure (4.4 times). However, rheumatoid factor was not found to increase the risk of heart disease in women.
The findings add more weight to the growing evidence that inflammation is implicated in atherosclerosis - a hardening of the arteries, when fats are deposited in the artery walls. It also raises the possibility that auto-immune processes and rheumatoid factor in particular may actually have a role in the disease process itself.
This build up of fatty deposits reduces blood supply to the heart (known as ischaemic heart disease) leading to angina and an increased risk of heart attack.
Rheumatoid factor is an auto-antibody present in up to 15% of adults and is strongly associated with rheumatoid arthritis. Chronic inflammatory diseases, such as rheumatoid arthritis, have been shown previously to increase the risk of ischaemic heart disease. However, the prevalence of rheumatoid arthritis in men in the UK is only about 0.4 per cent, so rheumatoid factor therefore seems to be an independent risk factor in men. Rheumatoid factor can be measured by a simple blood test available in all hospitals.
The study involved 567 men and 589 women born in Hertfordshire between 1931 and 1937 who were assessed for a history of ischaemic heart disease, rheumatoid factor and traditional risk factors for heart disease. They were also assessed for other common auto-antibodies (antinuclear antibodies and anticardiolipin antibodies), but no link to increased risk of ischaemic heart disease was found.
Another inflammatory marker C-reactive protein has also been linked to the development of ischaemic heart disease in previous studies.
The autoantibody rheumatoid factor may be an independent risk factor for ischaemic heart disease in men
Online First Heart 2007;0:1-5. doi: 10.1136/hrt.2006.097816
www.heart.bmj.com
Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=73015
Tuesday, April 24, 2007
Contemporary Biomarkers - Massachusetts General Hospital
Dr. Thomas J. Wang, Cardiologist, Medicine Department, Massachusetts General Hospital
Should Biomarkers Be Assessed in All Healthy People?
Although the New England Journal of Medicine study confirmed that contemporary biomarkers are associated with the risk of CVD and death, Dr. Wang says that these biomarkers add only moderately to traditional risk factors when assessing the future risk of cardiovascular events in healthy people. “Even in cases when individuals had increased levels of the biomarkers we assessed, they were unlikely to experience an event during the follow-up period. Our data reemphasize the importance of assessing traditional risk factors for each individual. Our results don’t support the idea of screening large populations of healthy people for high levels of these biomarkers.”
Routine measurement of novel biomarkers would be justified if they added to clinicians’ ability to predict risk of death and future CVD events, according to Dr. Wang. “These biomarkers appeared to add only modestly to our predictive ability in the community-based population of people we examined.” However, Dr. Wang adds that it is important to note that the study assessed only healthy individuals. He concedes that the investigators did not examine patients who already had CVD. “Our conclusions cannot and do not exclude the possibility that these biomarkers could be useful in specific patient groups. For example, these biomarkers might more accurately stratify patients at intermediate risk as determined by traditional risk factors.”
The Next Mission: Identify New Biomarkers
Dr. Wang says that the next step in trying to identify healthy patients who are at risk for CVD is to continue using traditional risk factors in prediction models and to identify new biomarkers related to CVD. “There is hope that other biomarkers that have yet to be discovered may better predict and assess cardiovascular risk in healthy individuals,” he says. “While the traditional biomarkers we assessed in our study do contribute to CVD prediction when patients have the disease, they are not good enough to predict risk in healthy people.” Other possible biomarker candidates related to CVD have been identified in recent investigations. “The key now,” Dr. Wang says, “is to study these other biomarkers and determine if it’s possible that some of them may do a better job in healthy cohorts. More research is required, but there is optimism in that our current list of CVD biomarkers will increase in the next five to 10 years. When that happens, we may be able to substantially increase our ability to predict CVD risk in the general population.” Thomas J. Wang, MD has indicated to Physician’s Weekly that he has or has had no financial interests to report.
Contemporary Biomarkers
N Engl J Med 2007; 356:1472-1475, Apr 5, 2007
Multiple Biomarkers for the Prediction of First Major Cardiovascular Events and Death
Thomas J. Wang, M.D., Philimon Gona, Ph.D., Martin G. Larson, Sc.D., Geoffrey H. Tofler, M.D., Daniel Levy, M.D., Christopher Newton-Cheh, M.D., M.P.H., Paul F. Jacques, D.Sc., Nader Rifai, Ph.D., Jacob Selhub, Ph.D., Sander J. Robins, M.D., Emelia J. Benjamin, M.D., Sc.M., Ralph B. D'Agostino, Ph.D., and Ramachandran S. Vasan, M.D.
ABSTRACT
Background Few investigations have evaluated the incremental usefulness of multiple biomarkers from distinct biologic pathways for predicting the risk of cardiovascular events.
Methods We measured 10 biomarkers in 3209 participants attending a routine examination cycle of the Framingham Heart Study: the levels of C-reactive protein, B-type natriuretic peptide, N-terminal pro–atrial natriuretic peptide, aldosterone, renin, fibrinogen, D-dimer, plasminogen-activator inhibitor type 1, and homocysteine; and the urinary albumin-to-creatinine ratio.
Results During follow-up (median, 7.4 years), 207 participants died and 169 had a first major cardiovascular event. In Cox proportional-hazards models adjusting for conventional risk factors, the following biomarkers most strongly predicted the risk of death (each biomarker is followed by the adjusted hazard ratio per 1 SD increment in the log values): B-type natriuretic peptide level (1.40), C-reactive protein level (1.39), the urinary albumin-to-creatinine ratio (1.22), homocysteine level (1.20), and renin level (1.17). The biomarkers that most strongly predicted major cardiovascular events were B-type natriuretic peptide level (adjusted hazard ratio, 1.25 per 1 SD increment in the log values) and the urinary albumin-to-creatinine ratio (1.20). Persons with "multimarker" scores (based on regression coefficients of significant biomarkers) in the highest quintile as compared with those with scores in the lowest two quintiles had elevated risks of death (adjusted hazard ratio, 4.08; P<0.001) p="0.02)." color="#000099">
Multiple Biomarkers for the Prediction of First Major Cardiovascular Events and Death
Thomas J. Wang, M.D., Philimon Gona, Ph.D., Martin G. Larson, Sc.D., Geoffrey H. Tofler, M.D., Daniel Levy, M.D., Christopher Newton-Cheh, M.D., M.P.H., Paul F. Jacques, D.Sc., Nader Rifai, Ph.D., Jacob Selhub, Ph.D., Sander J. Robins, M.D., Emelia J. Benjamin, M.D., Sc.M., Ralph B. D'Agostino, Ph.D., and Ramachandran S. Vasan, M.D.
ABSTRACT
Background Few investigations have evaluated the incremental usefulness of multiple biomarkers from distinct biologic pathways for predicting the risk of cardiovascular events.
Methods We measured 10 biomarkers in 3209 participants attending a routine examination cycle of the Framingham Heart Study: the levels of C-reactive protein, B-type natriuretic peptide, N-terminal pro–atrial natriuretic peptide, aldosterone, renin, fibrinogen, D-dimer, plasminogen-activator inhibitor type 1, and homocysteine; and the urinary albumin-to-creatinine ratio.
Results During follow-up (median, 7.4 years), 207 participants died and 169 had a first major cardiovascular event. In Cox proportional-hazards models adjusting for conventional risk factors, the following biomarkers most strongly predicted the risk of death (each biomarker is followed by the adjusted hazard ratio per 1 SD increment in the log values): B-type natriuretic peptide level (1.40), C-reactive protein level (1.39), the urinary albumin-to-creatinine ratio (1.22), homocysteine level (1.20), and renin level (1.17). The biomarkers that most strongly predicted major cardiovascular events were B-type natriuretic peptide level (adjusted hazard ratio, 1.25 per 1 SD increment in the log values) and the urinary albumin-to-creatinine ratio (1.20). Persons with "multimarker" scores (based on regression coefficients of significant biomarkers) in the highest quintile as compared with those with scores in the lowest two quintiles had elevated risks of death (adjusted hazard ratio, 4.08; P<0.001) p="0.02)." color="#000099">
Source Information From the Framingham Heart Study, Framingham, MA (T.J.W., P.G., M.G.L., D.L., C.N.-C., S.J.R., E.J.B., R.B.D., R.S.V.); the Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School (T.J.W., C.N.-C.), and the Department of Mathematics and Statistics, Boston University (P.G., M.G.L., R.B.D.) — both in Boston; the Royal North Shore Hospital, Sydney (G.H.T.); the National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); and the Jean Mayer Department of Agriculture Human Nutrition Research Center on Aging, Tufts University (P.F.J., J.S.), the Department of Laboratory Medicine, Children's Hospital, Harvard Medical School (N.R.), and the Preventive Medicine and Cardiology Sections (D.L., E.J.B., R.S.V.) and the Division of Endocrinology, Nutrition, and Diabetes (S.J.R.), Boston Medical Center, Boston University School of Medicine — all in
Texto completo (p/ assinantes): http://content.nejm.org/cgi/content/full/355/25/2631
Texto completo (p/ assinantes): http://content.nejm.org/cgi/content/full/355/25/2631
Thursday, April 19, 2007
Brain Natriuretic Peptide (BNP) and Heart Failure
Protein Monitoring Improved Heart Failure Treatment French trial found fewer deaths and hospital stays
WEDNESDAY, April 18 (HealthDay News) -- A trial that used blood levels of a biomarker called brain natriuretic peptide (BNP) to guide treatment of heart failure more than halved the incidence of death or hospitalization for the condition over 15 months, French cardiologists report.
Just 24 percent of the 110 trial participants whose drug treatment was adjusted according to BNP levels reached those critical end points of death or hospitalization. That compared to 52 percent of those who did not get BNP monitoring.
There were seven deaths from heart failure in the BNP-monitored group, compared to 11 in the non-monitored patients. The overall incidence of hospitalization was about the same in both groups, but just 22 hospital stays due to heart failure complications in the monitored group compared to 48 among patients whose BNP levels were not monitored.
The major difference in medical treatment was use of higher doses of beta-blocker and ACE inhibitor drugs in the BNP-monitored group, the researchers said.
BNP is a protein produced by the muscle cells of the heart ventricles as a response to excess stretching of those cells. Tests of BNP blood levels are used to help diagnosis heart failure, a condition in which the heart progressively loses its ability to pump blood, and to assess the prognosis for people with heart failure. Most drugs used to treat heart failure lower BNP levels.
The study participants, whose average age was 65, had essentially similar symptoms at the start of the trial, although those in the BNP-monitored group had a slightly lower average ejection fraction, which measures the heart's blood-pumping ability.
The findings are published in the April 24 issue of the Journal of the American College of Cardiology .
WEDNESDAY, April 18 (HealthDay News) -- A trial that used blood levels of a biomarker called brain natriuretic peptide (BNP) to guide treatment of heart failure more than halved the incidence of death or hospitalization for the condition over 15 months, French cardiologists report.
Just 24 percent of the 110 trial participants whose drug treatment was adjusted according to BNP levels reached those critical end points of death or hospitalization. That compared to 52 percent of those who did not get BNP monitoring.
There were seven deaths from heart failure in the BNP-monitored group, compared to 11 in the non-monitored patients. The overall incidence of hospitalization was about the same in both groups, but just 22 hospital stays due to heart failure complications in the monitored group compared to 48 among patients whose BNP levels were not monitored.
The major difference in medical treatment was use of higher doses of beta-blocker and ACE inhibitor drugs in the BNP-monitored group, the researchers said.
BNP is a protein produced by the muscle cells of the heart ventricles as a response to excess stretching of those cells. Tests of BNP blood levels are used to help diagnosis heart failure, a condition in which the heart progressively loses its ability to pump blood, and to assess the prognosis for people with heart failure. Most drugs used to treat heart failure lower BNP levels.
The study participants, whose average age was 65, had essentially similar symptoms at the start of the trial, although those in the BNP-monitored group had a slightly lower average ejection fraction, which measures the heart's blood-pumping ability.
The findings are published in the April 24 issue of the Journal of the American College of Cardiology .
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