Plasma galectin-3 as a novel biomarker to cardiac events in very high-risk atherosclerotic cardiovascular disease population: a prospective study in an upper-middle-income country

Background Galectin-3 is a soluble b-galactosidase-binding lectin which plays an important role as the main regulator in the inflammatory and fibrosis processes released by macrophage cells. Galectin-3 is often referred as a next-generation biomarker in detecting early stages of various diseases. Several recent studies have aimed to unveil the potential of plasma Galectin-3 as a prognostic indicator for coronary artery disease (CAD). No prior research has been conducted in Indonesia to evaluate the prognostic value of Galectin-3 in individuals with CAD. Objective This study aims to evaluate the prognostic value of plasma Galectin-3 in the population with atherosclerotic cardiovascular disease (ASCVD), specifically those categorized as very high-risk according to the risk stratification guidelines. Method: This study was a prospective cohort conducted on 208 individuals from three distinct centers in Indonesia, acquired through purposive sampling. The participants in this study were individuals between the ages of 18 and 80 who had previously undergone elective coronary artery bypass grafting (CABG), elective percutaneous coronary intervention (PTCA), or experienced acute coronary syndrome [acute myocardial infarct with ST elevation (STEMI), non-ST elevation MI (NSTEMI) including those undergoing primary PCI, and unstable angina] within the past 6 months to 2 years. Patients were monitored and followed up for up to 12 months from the time of recruitment and plasma sampling. Patients who experienced re-hospitalization and mortality during the follow-up period were counted as deceased. Each instance of multiple rehospitalizations for one patient was considered a single occurrence. The Galectin-3 value in continuous variable form was converted into a binary predictor variable with a cut-off value of 17.7 ng/mL based on previous studies. The relationship between Galectin-3 levels and cardiac events (re-hospitalization or mortality) was analyzed using Kaplan-Meier product limit estimation and univariate Cox proportional hazards regression analysis to estimate the hazard ratio (HR) and 95% confidence interval. Results The Kaplan-Meier survival analysis revealed that the rate of cardiac events at Galectin-3 levels ≥ 17.7 ng/mL was higher when compared to Galectin-3 levels < 17.7 ng/mL, and was statistically significant with p < 0.05 (p = 0.016, χ2 = 5.829). Cox proportional hazards regression analysis shows Galectin-3 to be a significant predictor to assess the prognosis of cardiac events in very high-risk ASCVD population [hazard ratio (HR) 3.39, p = 0.024, 95% CI 1.174 – 9.791]. Conclusion There is a significant correlation between plasma Galectin-3 levels and cardiac events such as re-hospitalization and mortality, establishing plasma Galectin-3 as a novel and important prognostic value in very high-risk ASCVD population.