title: Soluble CD40L: risk prediction after acute coronary syndromes.
abstract: BACKGROUND
  Elevated plasma concentrations of soluble CD40 ligand (sCD40L) indicate increased risk for future cardiovascular events in apparently healthy women. This study tested the hypothesis that plasma sCD40L, alone or in combination with troponin (cTnI) or C-reactive protein (CRP), may identify patients with acute coronary syndromes at heightened risk for recurrent cardiac events.
  
  
  RESULTS
  In a nested case-control study (cases, n=195; controls, n=195) within the OPUS-TIMI16 trial, patients with the prespecified study end points death, myocardial infarction (MI), or congestive heart failure (CHF) within 10 months had significantly higher median (25th, 75th percentiles) sCD40L plasma levels than did controls (0.78 [0.34, 1.73] ng/mL versus 0.52 [0.16, 1.42] ng/mL, P<0.002). After adjustment for other risk predictors and levels of cTnI and CRP, sCD40L levels above median were associated with higher risk for death, MI, and the composite death/MI or death/MI/CHF (adjusted hazard ratios, 1.9 [P<0.05], 1.9 [P<0.001], 1.9 [P<0.001], and 1.8 [P<0.01], respectively). Interestingly, patients with elevated plasma levels of sCD40L and cTnI showed a markedly increased risk of death, MI, or death/MI/CHF compared with patients with the lowest levels of both markers (adjusted hazard ratios, 12.1, 7.2, and 4.3, respectively; all P<0.01).
  
  
  CONCLUSIONS
  Elevated plasma levels of sCD40L identify patients with acute coronary syndromes at heightened risk of death and recurrent MI independent of other predictive variables, including cTnI and CRP. Notably, combined assessment of sCD40L with cTnI complements prognostic information for death and MI.
authors.affiliation: Donald W. Reynolds Cardiovascular Clinical Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
authors.forename: Nerea
authors.initials: N
authors.lastname: Varo
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.forename: Peter
authors.initials: P
authors.lastname: Libby
authors.forename: David A
authors.initials: DA
authors.lastname: Morrow
authors.forename: Sabina A
authors.initials: SA
authors.lastname: Murphy
authors.forename: Rebecca
authors.initials: R
authors.lastname: Nuzzo
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
authors.forename: Uwe
authors.initials: U
authors.lastname: Schönbeck
mesh_terms: D000208:Acute Disease; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D023201:CD40 Ligand / Q000097:blood*; D016022:Case-Control Studies; D003327:Coronary Disease / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors; D013577:Syndrome; D019210:Troponin I / Q000097:blood
chemical_list: D019210:Troponin I; D023201:CD40 Ligand; D002097:C-Reactive Protein