title: Associations of mid-regional pro-adrenomedullin levels to cardiovascular and metabolic abnormalities, and mortality in an elderly population from the community.
abstract: BACKGROUND
  The mid-regional part of the prohormone of adrenomedullin (MR-proADM) is emerging as a novel risk indicator in patients with cardiac disease. We investigated MR-proADM levels and their changes over 5 years in elderly community-dwellers, together with the underlying cardiovascular and metabolic conditions, and the prognostic implications of these measurements.
  
  
  RESULTS
  MR-proADM was analyzed using a sandwich immunoassay (Thermo Fisher Scientific) in participants from the PIVUS study. Measurements were performed at 70 (n=1002) and 75 years of age (n=795) together with various measurements of other markers of cardiovascular function. In cross-sectional analyses, MR-proADM was independently related to current smoking, renal dysfunction, obesity, lower left-ventricular ejection fraction, and higher levels of N-terminal pro-B-type natriuretic peptide and C-reactive protein. There were no independent associations to other cardiovascular risk factors or vascular pathologies. MR-proADM levels predicted all-cause mortality during 8.0 years of follow-up independent of cardiovascular risk indicators (adjusted HR 5.1 [95% CI 2.8-9.5]; p<0.001) using results obtained at 70 and 75 years as updated covariates. Baseline MR-proADM levels improved prognostic discrimination (IDI=0.018 [p=0.001]). Also the change in MR-proADM levels over time independently predicted all-cause mortality occurring after 75 years (adjusted HR 13.4 [95% CI 3.5-50.5]; p<0.001).
  
  
  CONCLUSIONS
  MR-proADM levels in the elderly integrate information on several relevant aspects in cardiovascular disease, namely cardiovascular risk factors including obesity, low-grade inflammation, renal dysfunction and left-ventricular abnormalities. Furthermore, MR-proADM and its changes over time predicted mortality, and might provide utility as an indicator of the overall cardiovascular risk burden.
authors.affiliation: Department of Medical Sciences, Uppsala University, Sweden. Electronic address: kai.eggers@ucr.uu.se.
authors.forename: Kai M
authors.initials: KM
authors.lastname: Eggers
authors.forename: Per
authors.initials: P
authors.lastname: Venge
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
authors.forename: Lars
authors.initials: L
authors.lastname: Lind
mesh_terms: D053607:Adrenomedullin / Q000096:biosynthesis / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000097:blood* / Q000401:mortality*; D011159:Population Surveillance / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012111:Residence Characteristics; D013548:Sweden / Q000453:epidemiology; D014664:Vasodilation / Q000502:physiology
chemical_list: D015415:Biomarkers; D053607:Adrenomedullin
keywords: Adrenomedullin; Biomarkers; General population; Mortality; Risk prediction