Abstract 13402: The Association of Plasma Lactate with Incident Cardiovascular Outcomes: The Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Introduction: Low oxidative capacity may play a role in the development of age-related degenerative diseases including cardiovascular disease (CVD). Plasma lactate is a marker of low oxidative capacity that can be assessed in epidemiologic studies.

Hypothesis: Elevated plasma lactate at rest is associated with incident CVD independently of potential confounders in the general population, and its association may vary across specific CVDs.

Methods: We studied 10,006 participants in the ARIC Study without prevalent CVD at baseline (visit 4, 1996-98). We used Cox proportional hazards models to estimate hazard ratios (HRs) of incident coronary heart disease (CHD), stroke, and heart failure (HF) by quartiles of plasma lactate at rest (Q1 <5.3 mg/dL, Q2 5.4-6.6, Q3 6.7-8.6, and Q4 ≥8.7).

Results: During median follow-up time of 10.7 years, there were 1,105 CHD cases, 379 stroke cases, and 820 HF cases. There was a significant graded relationship between lactate and CVD events in the demographically adjusted model (all Ps for trend <0.001) (Table). After adjustment for other potential confounders, the association remained significant for HF (HR for Q4 vs. Q1, 1.35 [95% CI, 1.07-1.71], trend P <0.013) but not for CHD (1.02 [0.84-1.24]) and stroke (1.26 [0.91-1.75]). The results for HF were robust across multiple subgroups according to demographic and clinical factors, after further adjusting for N-terminal pro-B-type natriuretic peptide, and after excluding participants with incident HF within three years.

Conclusion: Elevated plasma lactate was associated with incident CVD in middle-aged adults. The association with HF was independent of CVD risk factors and was particularly robust. Our findings are in line with the fact that the heart relies on the oxidation of substrates for energy generation and suggest that low resting oxidative capacity plays an important role in the development of cardiac dysfunction.