What is the clinical evidence from this study?

Study design: Cohort. Population: Atherosclerotic coronary heart disease (n=10803). Intervention: Ceramide- and phospholipid-based risk score vs. Per standard deviation increase. Primary outcome: CVD mortality (HR 1.44, 95% CI 1.28-1.63).

What does this research mean for the field?

A ceramide- and phospholipid-based risk score efficiently predicts residual cardiovascular event risk in patients with coronary artery disease. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine whether combining plasma ceramides with phosphatidylcholines improves the prediction of cardiovascular events in patients with coronary artery disease.

April 21, 2026European Heart JournalOpen Access

Development and validation of a ceramide- and phospholipid-based cardiovascular risk estimation score for coronary artery disease patients

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Key result

Ceramide-phospholipid score linked to ~44% higher CV mortality per SD in CAD.

HR 1.44
95% CI 1.28-1.63
n=10,803

Why the study?

Distinct ceramide lipids and phospholipids have been linked to cardiovascular disease risk, but their combined predictive value in coronary artery disease patients was unclear.

Does a ceramide- and phospholipid-based risk score predict cardiovascular mortality in patients with coronary artery disease?

Key Points

To determine whether combining plasma ceramides with phosphatidylcholines improves the prediction of cardiovascular events in patients with coronary artery disease.
Quantified circulating ceramides and phosphatidylcholines using liquid chromatography-mass spectrometry across three independent cohorts: WECAC (N = 3,789), the LIPID trial (N = 5,991), and KAROLA (N = 1,023).
Derived a risk score in the WECAC cohort using lipid species with the highest prognostic value and subsequently validated the score in the LIPID and KAROLA cohorts.
The lipid risk score was significantly associated with cardiovascular mortality, yielding multiadjusted hazard ratios per standard deviation of 1.44 (95% CI, 1.28–1.63) in WECAC, 1.47 (95% CI, 1.34–1.61) in LIPID, and 1.69 (95% CI, 1.31–2.17) in KAROLA.
Combining the lipid score with high-sensitivity troponin T increased hazard ratios to 1.63 (95% CI, 1.44–1.85) in WECAC and 2.04 (95% CI, 1.57–2.64) in KAROLA, yielding a C-statistic of 0.76 for cardiovascular death when integrated with sex and age.

Study Design

Type

Cohort (n=10,803)

Multicenter

Yes

Structured PICO

Does a ceramide- and phospholipid-based risk score predict cardiovascular mortality in patients with coronary artery disease?

Population

10,803 patients with atherosclerotic coronary heart disease across three independent cohort studies.

Exposure

Ceramide- and phospholipid-based cardiovascular risk estimation score

Outcome

Cardiovascular disease events, specifically cardiovascular mortalityhard clinical

Main Result

Hazard Ratio: 1.44 (95% CI 1.28–1.63)

A novel ceramide- and phospholipid-based risk score can effectively predict residual cardiovascular mortality risk in patients with established coronary artery disease.

Discussion

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Implication

May refine residual risk stratification in CAD; leaves open utility for guiding therapy pending randomized trials.

Cite This Study

Hilvo et al. (2019) conducted a cohort in Atherosclerotic coronary heart disease (n=10,803). Ceramide- and phospholipid-based risk score vs. Per standard deviation increase was evaluated on CVD mortality (HR 1.44, 95% CI 1.28-1.63). A ceramide- and phospholipid-based risk score significantly predicted cardiovascular mortality in patients with coronary artery disease (HR per standard deviation 1.44; 95% CI 1.28-1.63 in the development cohort).

synapsesocial.com/papers/69e7410329aee836d6f4d2fc https://doi.org/10.1093/eurheartj/ehz387

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Development and validation of a ceramide- and phospholipid-based cardiovascular risk estimation score for coronary artery disease patients

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Development and validation of a ceramide- and phospholipid-based cardiovascular risk estimation score for coronary artery disease patients

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

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