Abstract 11415: NGAL is Independently Associated with Cardiovascular Disease and All-Cause Mortality in Community-Dwelling Older Adults: The Rancho Bernardo Study
Introduction: Neutrophil gelatinase associated lipocalin (NGAL) is a novel marker of acute kidney injury. Although expressed in atherosclerosis, its association with cardiovascular disease (CVD) in the community has not been reported. We tested the hypothesis that NGAL is associated with cardiovascular and all-cause mortality in community-dwelling older adults.
Methods: We measured plasma NGAL, NT-proBNP, and CRP levels in 1393 Rancho Bernardo Study participants without CVD, mean age 70, and followed them for a mean of 11 yrs.
Results: There were 436 deaths (169 from CVD). In models adjusted for traditional CVD risk factors (RFs), BMI, and creatinine clearance, NGAL was a significant predictor of both CVD mortality (HR per SD log increase: 1.33, 95% CI [1.12-1.57]) and all-cause mortality (HR 1.19 [1.07-1.32]). After further adjusting for NT-proBNP and CRP, NGAL remained an independent predictor of both outcomes (Table). NGAL improved the c-statistic from 0.835 to 0.842 for prediction of CVD death (p=0.001). Net reclassification improvement (NRI>0) with the addition of NGAL was 18% (p=0.02); the integrated discrimination index was also significant (p=0.01). Participants in the upper half of both NGAL and NT-proBNP had an increased risk of CVD death vs. those with only NT-proBNP elevated (HR 1.43 [1.12-1.82]) (Figure).
Conclusions: NGAL is a significant predictor of mortality in community-dwelling older adults, independent of traditional RFs and renal function, and adds incremental value to NT-proBNP and CRP. The potential impact of these results includes providing insight into new mechanisms of CVD and the possibility of improving screening, intervention and prevention.
- © 2011 by American Heart Association, Inc.