Abstract 17646: Plasma Levels of ST2 in the Community: ST2 is Associated with Increased Risk of Incident Heart Failure and Mortality but not with Altered Ventricular Function

Abstract

Background: ST2 is implicated in the pathogenesis of inflammation and fibrosis in experimental heart failure (HF). Circulating levels of ST2 have prognostic value in overt HF. The association of ST2 levels with pre-clinical LV dysfunction, incident HF and mortality in the general population is undefined.

Methods: A random sample of Olmsted County, MN residents aged ≥ 45 years and free from clinical HF were studied (clinical, lab, and echo data and stored plasma) between 1997 and 2000. ST2 levels at study entry and follow up for incident HF and all-cause mortality were obtained through 2011. The association between ST2 levels and echo indices at study entry and between quartiles of ST2 levels and outcomes was assessed.

Results: Of 1831 subjects enrolled, 730 were normal (no CV disease, normal EF and diastolic function). In normals, ST2 levels (median (IQR)) were lower in females (23.3 ng/mL (19.0-28.0) than males (28.9 ng/mL (21.6-35.1); p<0.0001) but were not associated with age, renal function or obesity. In the entire population, adjusting for sex, ST2 levels were not significantly associated with cardiac structure or function (Table 1). 190 subjects developed HF and 290 died. ST2 predicted incident HF and mortality even after adjustment for clinical factors and other prognostic biomarkers (Table 2).

Conclusions: In normal individuals, ST2 levels vary with sex. In the general population, ST2 levels are associated with increased risk for incident HF and mortality but not with cardiac structure or function prior to HF onset. These data may suggest that activation of ST2 promotes HF by pathways distinct from LV remodeling.