Abstract 13175: Myeloperoxidase (MPO) is an Independent Predictor of Adverse Cardiovascular Outcomes in Patients with Stable Coronary Artery Disease
Background: The leukocyte enzyme myeloperoxidase (MPO) is found within vulnerable plaques prone to rupture and in animal models has been implicated in cardiac remodeling and the development of heart failure. MPO levels have been found to predict cardiovascular outcomes in patients presenting with chest pain and in those with acute coronary syndromes. However, the ability of MPO to predict cardiovascular outcomes in stable CAD remains undefined.
Methods: MPO was measured (Dimension Vista 1500, Siemens Healthcare Diagnostics, Siemens, assay range 20–5000 pmol/L with a CV of 3.8% at 428 pmol/L) on baseline samples in 3766 pts enrolled in PEACE, a placebo controlled trial of trandolapril in stable CAD. Pts were followed for a median of 4.8 y for CV death (CVD), MI, stroke and congestive heart failure (CHF). Patients were divided into quartiles based on MPO levels. Multivariable Cox regression was used to adjust for clinical factors and biomarkers.
Results: The median level of MPO was 257 pmol/L (IQR 146–366 pmol/L). Patients with higher levels of MPO were more likely to be male and current smokers, have hypertension and diabetes, and less likely to be on lipid-lowering treatment. Higher levels of MPO were associated with an increased risk of CVD (Ptrend 0.0001) and CHF (Ptrend 0.002), but not MI (Ptrend 0.23) or stroke (Ptrend 0.13). The association with CVD/CHF remained significant after adjusting for clinical factors (age, sex, HTN, diabetes, smoking, SBP, prior MI, lipid-lowering therapy, trandolapril treatment group, eGFR, LVEF, apoB, and apoA) with a Ptrend of 0.0009 and after further adjusting for biomarkers (hs-CRP, Lp-PLA2, NT-proBNP, and hs-TnT) with a Ptrend 0.013 (Figure).
Conclusion: In patients with stable CAD, an elevated level of MPO is a significant predictor of clinically significant cardiovascular outcomes, specifically CVD and CHF, independent of clinical risk factors and other established biomarkers.
- © 2010 by American Heart Association, Inc.