Key result
Higher GDF-15 linked to ~50% increased all-cause mortality risk in older adults without CVD.
Why the study?
Growth-differentiation factor-15 (GDF-15) is emerging as a prognostic marker in patients with cardiovascular disease, but its prognostic value in community-dwelling adults without known heart disease had not been reported.
Does plasma GDF-15 level predict mortality in community-dwelling older adults without known cardiovascular disease?
Cohort (n=1,391)
Does plasma GDF-15 level predict mortality in community-dwelling older adults without known cardiovascular disease?
Hazard Ratio: 1.5 (95% CI 1.3–1.8)
p-value: p=<0.0001
GDF-15 is a robust, independent predictor of all-cause, cardiovascular, and noncardiovascular mortality in community-dwelling older adults without known CVD, adding incremental prognostic value to traditional risk factors and NT-proBNP.
May refine mortality risk assessment in older adults without CVD; leaves open whether measurement alters management or outcomes.
BACKGROUND: Growth-differentiation factor-15 (GDF-15) is emerging as a prognostic marker in patients with cardiovascular disease (CVD), but its prognostic value in community-dwelling adults has not been reported. We hypothesized that GDF-15 would add incremental power for prediction of mortality in a population of community-dwelling older adults without known heart disease. METHODS AND RESULTS: We measured plasma GDF-15, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and C-reactive protein levels in 1391 Rancho Bernardo Study participants, mean age 70 years, with no history of CVD and followed them for a mean of 11 years. In models adjusted for traditional CVD risk factors, GDF-15 was a robust predictor of all-cause, cardiovascular, and noncardiovascular mortality. GDF-15 was a stronger predictor of all-cause mortality than either NT-proBNP or C-reactive protein (hazard ratio [95% confidence interval] per SD log(10) units 1.5 [1.3 to 1.8], P<0.0001 for GDF-15 versus 1.3 [1.2 to 1.5], P<0.0001 for NT-proBNP; C-reactive protein was not a significant predictor). Among biomarkers considered, only GDF-15 predicted noncardiovascular death (hazard ratio 1.6 [1.4 to 2.0], P<0.0001). Growth differentiation factor-15 improved discrimination and modestly but significantly improved reclassification for all-cause and noncardiovascular mortality with borderline improvement for cardiovascular mortality; NT-proBNP significantly improved reclassification for all-cause and for cardiovascular mortality; C-reactive protein did not improve reclassification for any end point tested. Participants in the highest quartile of both GDF-15 and NT-proBNP had an increased risk of death compared with participants with only NT-proBNP elevated (hazard ratio 1.5 [1.1 to 2.0], P=0.01). CONCLUSIONS: Growth differentiation factor-15 is a strong predictor of all-cause, cardiovascular, and noncardiovascular mortality in community-dwelling older individuals, adding incremental value to traditional risk factors and to NT-proBNP and C-reactive protein levels.
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Daniels et al. (2011) conducted a cohort in Community-dwelling older adults without known heart disease (n=1,391). Growth-differentiation factor-15 (GDF-15) vs. NT-proBNP and C-reactive protein was evaluated on All-cause mortality (HR 1.5, 95% CI 1.3 to 1.8, p=<0.0001). Elevated GDF-15 was a robust predictor of all-cause mortality in community-dwelling older adults without prior CVD (HR 1.5 per SD log10 units; 95% CI 1.3-1.8; P<0.0001).
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