Circulating des-acyl ghrelin improves cardiovascular risk prediction in older hypertensive patients.
Circulating des-acyl ghrelin improves cardiovascular risk prediction in older hypertensive patients.
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DOI：
10.1093/ajh/hpt232
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发表时间：
2014-05
影响因子：
3.2
通讯作者：
Y. Yano;M. Nakazato;K. Toshinai;T. Inokuchi;S. Matsuda;Toshiaki Hidaka;Manabu Hayakawa;K. Kangawa;K. Shimada;K. Kario
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文献类型：
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作者：
Y. Yano;M. Nakazato;K. Toshinai;T. Inokuchi;S. Matsuda;Toshiaki Hidaka;Manabu Hayakawa;K. Kangawa;K. Shimada;K. Kario
背景我们的目的是评估去酰基生长素释放肽（一种人体内生长素释放肽的丰富形式）循环水平对老年高血压患者心血管疾病（CVD）风险的预测价值。我们同时评估了其他生物标志物，如高分子量（HMW）脂联素，高敏C反应蛋白（hs-CRP）和纤溶酶原激活物抑制剂1（派-1），其在风险预测中的有用性。方法：我们招募了590名老年高血压患者（平均年龄= 72.9岁; 41.0%为男性）。CVD的发生率，包括冠状动脉疾病，中风，充血性心力衰竭和猝死，被前瞻性地确定。结果在平均2.8（SD = 0.7）年（1,653人-年）的时间内，有42例CVD事件。有CVD事件的患者基线时去酰基ghrelin水平低于无CVD事件的患者（中位数= 78.2 vs. 114.7 fmol/ml; P < 0.001）。其他生物标志物在有CVD事件的患者和无此类事件的患者之间无差异。经协变量校正的考克斯比例风险模型显示，去酰基生长素释放肽对数下降1-SD的患者中CVD事件的风险比为1.8（95%置信区间= 1.3-2.4）。在风险模型（包括年龄、当前吸烟、24小时收缩压、先前存在的CVD和颈动脉内膜中层厚度）中加入去酰基生长激素释放肽改善了C统计学（从0.683至0.721; P = 0.22），并导致净重新分类改善20.5%（P = 0.02）。相反，高分子量脂联素、hs-CRP和派-1对风险预测没有改善。结论：去酰基ghrelin改善了老年高血压患者CVD事件的预测。
BACKGROUND We aimed to assess the predictive value of circulating levels of des-acyl ghrelin, an abundant form of ghrelin in humans, for the risk of cardiovascular disease (CVD) in older hypertensive patients. We simultaneously evaluated other biomarkers, such as high-molecular-weight (HMW) adiponectin, high-sensitivity C-reactive protein (hs-CRP), and plasminogen activator inhibitor 1 (PAI-1), for their usefulness in risk prediction. METHODS We enrolled 590 older hypertensive patients (mean age = 72.9 years; 41.0% men). The incidences of CVD, including coronary artery disease, stroke, congestive heart failure, and sudden death, were prospectively ascertained. RESULTS During an average duration of 2.8 (SD = 0.7) years (1,653 person-years), there were 42 CVD events. Patients with CVD events had lower levels of des-acyl ghrelin at baseline than those without CVD events (median = 78.2 vs. 114.7 fmol/ml; P < 0.001). No difference was found among other biomarkers between the patients with CVD events and those without such events. The Cox proportional hazards model adjusted by covariables revealed that the hazard ratio for CVD events in patients with a 1-SD decrease of log des-acyl ghrelin was 1.8 (95% confidence interval = 1.3-2.4). Incorporation of des-acyl ghrelin in the risk model (including age, current smoking, 24-hour systolic blood pressure, preexisting CVD, and carotid intima-media thickness) improved the C statistics (from 0.683 to 0.721; P = 0.22) and resulted in a net reclassification improvement of 20.5% (P = 0.02). In contrast, HMW adiponectin, hs-CRP, and PAI-1 provided no improvement in risk prediction. CONCLUSIONS Des-acyl ghrelin improved the prediction of CVD events in older hypertensive patients.