Abstract 2561: Plasma Adrenomedullin Level is a Long-Term Prognostic Marker in Patients with Chronic Stable Cardiovascular Disease
Background: Plasma adrenomedullin (AM) levels are increased in proportion to the severity of cardiovascular disease such as heart failure, acute coronary syndrome, pulmonary hypertension, and hypertension. This study was designed to test the hypothesis that plasma AM may be a long-term prognostic marker in patients with stable cardiovascular disease by any cause.
Methods: A cohort of 592 subjects with stable chronic cardiovascular disease (ischemic heart disease (IHD)/heart failure (HF)/hypertension/hypertrophic cardiomyopathy (HCM)/pulmonary hypertension (PH)/other=111/110/139/25/61/146) was studied. Plasma AM and other neuro-humoral factors (atrial and brain natriuretic peptide (ANP, BNP), norepinephrine, renin, aldosterone) were measured in baseline and the rate of death from all causes was determined after a median follow-up of seven years.
Results: During follow-up, 90 patients died (IHD/HF/hypertension/HCM/PH/other = 12/19/7/5/26/21). The median AM level was lower in patients who survived than in those who died (6.4 vs 10.4 fmol/mL, P<0.05). Patients with AM levels in the highest quartile had a higher ANP, BNP, renin, aldosterone, norepinephrine and creatinine levels and were more likely to have a history of diabetes, hyperlipidemia, and heart failure than patients with AM levels in the lowest quartile. Kaplan-Meier survival analysis showed that survival rate was decreased according to the increase of AM. Univariate analysis revealed that higher plasma ANP, BNP, AM, norepinephrine and renin levels, lower GFR and body mass index, and the presence of a history of cerebral infarction and heart failure were associated with the mortality. By Cox multivariate proportional hazard analysis, high levels of AM (1 fmol increase; hazard ratio 1.16, 95 percent confidence interval, 1.01 to 1.35, p = 0.01) as well as BNP (100 pg increase; hazard ratio 1.20, 95 percent confidence interval, 1.00 to 1.41, p = 0.005) were significant independent predictors of the mortality.
Conclusions: These results suggest that plasma AM level is a marker of long-term mortality in patients with stable chronic cardiovascular disease independent of BNP and that plasma AM level provides prognostic information above that provided by conventional risk factors.