title: Prospective study of circulating soluble CD40 ligand concentrations and the incidence of cardiovascular disease in a nested prospective case-control study of older men and women.
abstract: BACKGROUND
  CD40 ligand(CD40L) is implicated in atherosclerotic plaque formation.
  
  
  OBJECTIVE
  We investigated prospective associations between circulating soluble CD40L and myocardial infraction (MI) or stroke in an older general population cohort, accounting for established and novel cardiovascular risk factors.
  
  
  METHODS
  Baseline serum CD40L (sCD40L) was measured in incident MI (n = 368) and stroke (n = 304) cases and two controls per case, 'nested' in prospective UK studies of 4252 men and 4286 women aged 60-79 years, sampled from general practices in Britain in 1998-2000, with 7-year follow-up for fatal and non-fatal MI and stroke.
  
  
  RESULTS
  sCD40L was higher in smokers and negatively associated with lung function and positively associated with total cholesterol and markers of inflammation, but not with other established cardiovascular disease (CVD) risk factors. Geometric mean sCD40L levels did not differ between MI cases and controls (5.94 ng mL(-1) vs. 5.82 ng mL(-1); P = 0.5) or between stroke cases and controls (5.61 ng mL(-1) vs. 5.28 ng mL(-1), P = 0.1). There was no strong evidence for elevated risk of MI or stroke in multivariable models comparing participants in the top to those in the bottom third of sCD40L. Age-adjusted odds ratios (ORs) were 1.39 [95% confidence interval (CI) 0.98, 1.96] for MI and 1.16 (0.78, 1.73) for stroke. These attenuated to 1.24 (95% CI 0.86, 1.79) and 1.18 (0.78, 1.78), respectively, after adjustment for established and novel CVD risk factors.
  
  
  CONCLUSIONS
  sCD40L is associated with other inflammatory markers but is not itself a strong independent risk marker for either stroke or MI.
authors.affiliation: Department of Primary Care and Population Health, UCL Medical School, Rowland Hill Street, London, UK. b.jefferis@ucl.ac.uk
authors.forename: B J
authors.initials: BJ
authors.lastname: Jefferis
authors.forename: P H
authors.initials: PH
authors.lastname: Whincup
authors.forename: P
authors.initials: P
authors.lastname: Welsh
authors.forename: S G
authors.initials: SG
authors.lastname: Wannamethee
authors.forename: A
authors.initials: A
authors.lastname: Rumley
authors.forename: D A
authors.initials: DA
authors.lastname: Lawlor
authors.forename: S
authors.initials: S
authors.lastname: Ebrahim
authors.forename: G D O
authors.initials: GD
authors.lastname: Lowe
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D023201:CD40 Ligand / Q000097:blood*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D018836:Inflammation Mediators / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology*; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000453:epidemiology*; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D023201:CD40 Ligand