Abstract 14940: Association of MCP-1, hsCRP, Neopterin, MMP-9 and NT-proBNP With Coronary Heart Disease Risk in Patients With Prior Stroke or Transient Ischemic Attack. Results of the Analysis of 13 Biomarkers From the SPARCL Trial
Background: Patients with prior strokes or transient ischemic attacks (TIAs) are at high risk of coronary heart disease (CHD). Established risk factors do not fully identify this high risk. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial evaluated the effect of atorvastatin on stroke risk in patients with a recent stroke or TIA and no known CHD. This analysis explored the relationships between levels of 13 biomarkers assessed from samples taken at trial enrollment and the occurrence of outcome major CHD events (non-fatal MI, cardiac death, or resuscitated cardiac arrest) during a median of 4.9 years of follow-up.
Methods and Results: Biomarkers were measured in 2639 of 4731 SPARCL subjects, including 193 of 201 subjects with major CHD events. Time to major CHD events was evaluated by Cox proportional hazard models for quartiles of biomarkers. In adjusted analyses comparing the highest with the lowest quartiles, monocyte chemoattractant protein-1 (MCP-1) (hazard ratio [HR]=2.46, P=0.0002), high-sensitivity C-reactive protein (hsCRP) (HR=2.29, P=0.003), neopterin (HR=2.06, P=0.005), N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) (HR=1.67, P=0.014) and matrix metalloproteinase-9 (MMP-9) (HR=1.63, P=0.028) were associated with the risk of outcome major CHD events (Figure). With the possible exception of MMP-9, treatment with atorvastatin did not modify the risk associated with these biomarkers. In ROC curve analyses, these five biomarkers improved CHD risk prediction beyond traditional risk factors. The relationships for other biomarkers to CHD risk were not statistically significant (Figure).
Conclusion: In patients with recent stroke or TIA and no known CHD, biomarkers MCP-1, hsCRP, neopterin, MMP-9 and NT-proBNP predict the risk of future CHD events and improve risk prediction over traditional risk factors.
- © 2013 by American Heart Association, Inc.