Prognosis and Reclassification by YKL‐40 in Stable Coronary Artery Disease
Background The inflammatory biomarker YKL‐40 has previously been studied as a potential risk marker in cardiovascular disease. We aimed to assess the prognostic reclassification potential of serum YKL‐40 in patients with stable coronary artery disease. Methods and Results The main study population w...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.014634 |
| _version_ | 1818315058144346112 |
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| author | Jakob Schroder Janus Christian Jakobsen Per Winkel Jørgen Hilden Gorm Boje Jensen Ahmad Sajadieh Anders Larsson Johan Ärnlöv Marina Harutyunyan Julia S. Johansen Erik Kjøller Christian Gluud Jens Kastrup |
| author_facet | Jakob Schroder Janus Christian Jakobsen Per Winkel Jørgen Hilden Gorm Boje Jensen Ahmad Sajadieh Anders Larsson Johan Ärnlöv Marina Harutyunyan Julia S. Johansen Erik Kjøller Christian Gluud Jens Kastrup |
| author_sort | Jakob Schroder |
| collection | DOAJ |
| description | Background The inflammatory biomarker YKL‐40 has previously been studied as a potential risk marker in cardiovascular disease. We aimed to assess the prognostic reclassification potential of serum YKL‐40 in patients with stable coronary artery disease. Methods and Results The main study population was the placebo group of the CLARICOR (Effect of Clarithromycin on Mortality and Morbidity in Patients With Ischemic Heart Disease) trial. The primary outcome was a composite of acute myocardial infarction, unstable angina pectoris, cerebrovascular disease, and all‐cause mortality. We used Cox proportional hazards regression models adjusted for C‐reactive protein level and baseline cardiovascular risk factors. Improvement in prediction by adding serum YKL‐40 to the risk factors was calculated using the Cox‐Breslow method and c‐statistic. A total of 2200 patients were randomized to placebo, with a follow‐up duration of 10 years. YKL‐40 was associated with an increased risk of the composite outcome (hazard ratio per unit increase in (YKL‐40) 1.13, 95% CI 1.03–1.24, P=0.013) and all‐cause mortality (hazard ratio 1.32, 95% CI 1.17–1.49, P<0.0001). Considering whether a composite‐outcome event was more likely to have, or not have, occurred to date, we found 68.4% of such predictions to be correct when based on the standard predictors, and 68.5% when serum YKL‐40 was added as a predictor. Equivalent results were obtained with c‐statistics. Conclusions Higher serum YKL‐40 was independently associated with an increased risk of adverse cardiovascular outcomes and mortality. Addition of YKL‐40 did not improve risk prediction in patients with stable coronary artery disease. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00121550. |
| first_indexed | 2024-12-13T08:59:30Z |
| format | Article |
| id | doaj.art-9f843d85bdcb456caaf6e47317d0da18 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T08:59:30Z |
| publishDate | 2020-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-9f843d85bdcb456caaf6e47317d0da182022-12-21T23:53:12ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-03-019510.1161/JAHA.119.014634Prognosis and Reclassification by YKL‐40 in Stable Coronary Artery DiseaseJakob Schroder0Janus Christian Jakobsen1Per Winkel2Jørgen Hilden3Gorm Boje Jensen4Ahmad Sajadieh5Anders Larsson6Johan Ärnlöv7Marina Harutyunyan8Julia S. Johansen9Erik Kjøller10Christian Gluud11Jens Kastrup12Department of Cardiology Bispebjerg Hospital University of Copenhagen Copenhagen DenmarkCopenhagen Trial Unit Centre for Clinical Intervention Research Rigshospitalet, Copenhagen University Hospital Copenhagen DenmarkCopenhagen Trial Unit Centre for Clinical Intervention Research Rigshospitalet, Copenhagen University Hospital Copenhagen DenmarkSection of Biostatistics Department of Public Health Research University of Copenhagen Copenhagen DenmarkDepartment of Cardiology Hvidovre Hospital Copenhagen University Hospital Copenhagen DenmarkDepartment of Cardiology Bispebjerg Hospital University of Copenhagen Copenhagen DenmarkDepartment of Medical Sciences Uppsala University Uppsala SwedenDepartment of Neurobiology, Care Sciences and Society/Division of Family Medicine Karolinska Institute Stockholm SwedenDepartment of Cardiology Rigshospitalet University of Copenhagen København DenmarkDepartment of Medicine Herlev and Gentofte Hospital Copenhagen DenmarkCopenhagen Trial Unit Centre for Clinical Intervention Research Rigshospitalet, Copenhagen University Hospital Copenhagen DenmarkCopenhagen Trial Unit Centre for Clinical Intervention Research Rigshospitalet, Copenhagen University Hospital Copenhagen DenmarkDepartment of Cardiology Rigshospitalet University of Copenhagen København DenmarkBackground The inflammatory biomarker YKL‐40 has previously been studied as a potential risk marker in cardiovascular disease. We aimed to assess the prognostic reclassification potential of serum YKL‐40 in patients with stable coronary artery disease. Methods and Results The main study population was the placebo group of the CLARICOR (Effect of Clarithromycin on Mortality and Morbidity in Patients With Ischemic Heart Disease) trial. The primary outcome was a composite of acute myocardial infarction, unstable angina pectoris, cerebrovascular disease, and all‐cause mortality. We used Cox proportional hazards regression models adjusted for C‐reactive protein level and baseline cardiovascular risk factors. Improvement in prediction by adding serum YKL‐40 to the risk factors was calculated using the Cox‐Breslow method and c‐statistic. A total of 2200 patients were randomized to placebo, with a follow‐up duration of 10 years. YKL‐40 was associated with an increased risk of the composite outcome (hazard ratio per unit increase in (YKL‐40) 1.13, 95% CI 1.03–1.24, P=0.013) and all‐cause mortality (hazard ratio 1.32, 95% CI 1.17–1.49, P<0.0001). Considering whether a composite‐outcome event was more likely to have, or not have, occurred to date, we found 68.4% of such predictions to be correct when based on the standard predictors, and 68.5% when serum YKL‐40 was added as a predictor. Equivalent results were obtained with c‐statistics. Conclusions Higher serum YKL‐40 was independently associated with an increased risk of adverse cardiovascular outcomes and mortality. Addition of YKL‐40 did not improve risk prediction in patients with stable coronary artery disease. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00121550.https://www.ahajournals.org/doi/10.1161/JAHA.119.014634CHI3L1cohort studycoronary atherosclerosisYKL‐40 |
| spellingShingle | Jakob Schroder Janus Christian Jakobsen Per Winkel Jørgen Hilden Gorm Boje Jensen Ahmad Sajadieh Anders Larsson Johan Ärnlöv Marina Harutyunyan Julia S. Johansen Erik Kjøller Christian Gluud Jens Kastrup Prognosis and Reclassification by YKL‐40 in Stable Coronary Artery Disease Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease CHI3L1 cohort study coronary atherosclerosis YKL‐40 |
| title | Prognosis and Reclassification by YKL‐40 in Stable Coronary Artery Disease |
| title_full | Prognosis and Reclassification by YKL‐40 in Stable Coronary Artery Disease |
| title_fullStr | Prognosis and Reclassification by YKL‐40 in Stable Coronary Artery Disease |
| title_full_unstemmed | Prognosis and Reclassification by YKL‐40 in Stable Coronary Artery Disease |
| title_short | Prognosis and Reclassification by YKL‐40 in Stable Coronary Artery Disease |
| title_sort | prognosis and reclassification by ykl 40 in stable coronary artery disease |
| topic | CHI3L1 cohort study coronary atherosclerosis YKL‐40 |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.014634 |
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