Abstract | OBJECTIVES: BACKGROUND: METHODS: We measured plasma NGAL levels in 1,393 Rancho Bernardo Study participants without CVD, mean age 70 years. Participants were followed for a mean time period of 11 years. RESULTS: During follow-up, 436 participants died (169 from CVD). In models adjusted for traditional CVD risk factors and creatinine clearance, NGAL was a significant predictor of CVD mortality (hazard ratio [HR] per SD log increase: 1.33, 95% confidence interval [CI]: 1.12 to 1.57), all-cause mortality (HR: 1.19, 95% CI: 1.07 to 1.32), and a combined cardiovascular endpoint (HR: 1.26, 95% CI: 1.10 to 1.45). After further adjusting for N-terminal pro- B-type natriuretic peptide ( NT-proBNP) and C-reactive protein (CRP), NGAL remained an independent predictor of each outcome. NGAL improved the C-statistic (0.835 to 0.842) for prediction of CVD death (p = 0.001). Net reclassification improvement (>0) with the addition of NGAL was 18% (p = 0.02); the integrated discrimination index was also significant (p = 0.01). Participants with NGAL and NT-proBNP above the median had increased risk of CVD death versus those with only NT-proBNP elevated (HR: 1.43, 95% CI: 1.12 to 1.82). CONCLUSIONS: Plasma NGAL is a significant predictor of mortality and CVD in community-dwelling older adults, independent of traditional risk factors and kidney 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.
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Authors | Lori B Daniels, Elizabeth Barrett-Connor, Paul Clopton, Gail A Laughlin, Joachim H Ix, Alan S Maisel |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 59
Issue 12
Pg. 1101-9
(Mar 20 2012)
ISSN: 1558-3597 [Electronic] United States |
PMID | 22421304
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Acute-Phase Proteins
- Biomarkers
- LCN2 protein, human
- Lipocalin-2
- Lipocalins
- Peptide Fragments
- Proto-Oncogene Proteins
- pro-brain natriuretic peptide (1-76)
- Natriuretic Peptide, Brain
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Topics |
- Acute-Phase Proteins
- Aged
- Aged, 80 and over
- Biomarkers
(blood)
- California
(epidemiology)
- Cardiovascular Diseases
(blood, diagnosis, mortality)
- Confounding Factors, Epidemiologic
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Independent Living
- Kaplan-Meier Estimate
- Lipocalin-2
- Lipocalins
(blood)
- Male
- Multivariate Analysis
- Myocardial Revascularization
- Natriuretic Peptide, Brain
(blood)
- Peptide Fragments
(blood)
- Proportional Hazards Models
- Proto-Oncogene Proteins
(blood)
- ROC Curve
- Risk Assessment
- Risk Factors
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