Abstract 3479: Serum Arylesterase Activity Predicts Major Adverse Cardiac Events Independent of B-type Natriuretic Peptide in Patients With Systolic Heart Failure
Background: Paraoxonase, an HDL associated protein thought to mediate some of the atheroprotective functions of HDL, catalyzes endogenous serum arylesterase activity. Diminished serum arylesterase activity is associated with heightened systemic oxidative stress and atherosclerosis risk, but their role in systolic heart failure remains unclear.
Methods: We measured serum arylesterase activity in 760 subjects with stable systolic heart failure (LVEF<50%), and prospectively followed major adverse cardiac events (MACE, including death, non-fatal MI, and stroke) for 3 years. B-type natriuretic peptide (BNP) and high-sensitivity C-reactive protein (hsCRP) were measured in Abbott Architect platform (Abbott Laboratories, Abbott Park IL).
Results: In our study cohort (mean age 64±11 years, 74% male, median LVEF 35%, median creatinine clearance [CrCl] 87 mg/dL), there was modest inverse correlation between arylesterase and BNP (r=−0.23, p<0.01), but weak correlations with LVEF (r=0.12, p<0.01) and hsCRP (r=−0.13, p<0.01). Lower serum arylesterase activity was associated with poorer outcomes (Quartile 4 versus Quartile 1, Hazard ratio 3.27, 95% confidence intervals 1.66 – 6.44, p<0.001). After adjusting for log(BNP), log(hsCRP), Framingham risk factors, and CrCl, the lowest quartile of arylesterase still maintains a 2.3-fold increased risk in MACE at 3 years (p=0.017). This is most apparent in all lower 3 quartiles (see Figure⇓).
Conclusion: In patients with chronic systolic heart failure, diminished serum arylesterase levels predicts higher long-term adverse cardiac event rates independent of established clinical and biochemical risk factors.