Why the study?
Cardiac biomarkers linked to atherosclerotic disease in the general population were hypothesized to also be associated with atherosclerotic cardiovascular disease in patients with CKD.
Are higher levels of cardiac biomarkers (NT-proBNP, hsTnT, GDF-15, sST2) associated with an increased risk of incident atherosclerotic disease in patients with mild to moderate CKD?
Are higher levels of cardiac biomarkers (NT-proBNP, hsTnT, GDF-15, sST2) associated with an increased risk of incident atherosclerotic disease in patients with mild to moderate CKD?
In patients with mild to moderate CKD, elevated levels of cardiac biomarkers (NT-proBNP, hsTnT, GDF-15, and sST2) are independently associated with an increased risk of incident atherosclerotic cardiovascular disease.
Cardiac biomarkers may refine ASCVD risk assessment in mild-moderate CKD; extends prior associations to this population but leaves open clinical utility.
Background: Several cardiac biomarkers of cardiac stress, inflammation, and fibrosis (N-terminal pro brain-type natriuretic peptide [NT-proBNP], high-sensitivity troponin T [hsTnT], growth differentiation factor 15 [GDF-15], and soluble ST2 [sST2]) have been associated with atherosclerotic disease in the general population. We hypothesized that these cardiac biomarkers may also be associated with the atherosclerotic cardiovascular disease in patients with CKD. Methods: We analyzed levels of NT-proBNP, hsTnT, GDF-15, and sST2 in a cohort of 2732 participants with mild to moderate CKD from the Chronic Renal Insufficiency Cohort (CRIC) study. Outcomes included incident atherosclerotic disease, defined as the first instance of myocardial infarction, stroke, or peripheral vascular disease. We used Cox proportional hazard models to the test the association of each cardiac biomarker with risk of incident atherosclerotic disease, adjusting for multiple possible confounders. Results: When modeled continuously (per SD increase in the log-transformed biomarker), NT-proBNP, hsTnT, GDF-15, and sST2 were significantly associated with incident atherosclerotic disease after adjustment for multiple potential confounders: (NT-proBNP HR, 1.51; 95% CI, 1.27 to 1.81; hsTnT HR, 1.61; 95% CI, 1.38 to 1.89; GDF-15 HR, 1.44; 95% CI, 1.19 to 1.73; and sST2 HR, 1.19; 95% CI, 1.04 to 1.36). Conclusions: NT-proBNP, hsTnT, GDF-15, and sST2 were significantly associated with incident atherosclerotic cardiovascular disease in patients with CKD. These associations may highlight important mechanisms for the development of atherosclerotic disease in CKD.
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Lidgard et al. (2022) studied this question.
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