title: Circulating des-acyl ghrelin improves cardiovascular risk prediction in older hypertensive patients.
abstract: 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.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yano
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Nakazato
authors.forename: Koji
authors.initials: K
authors.lastname: Toshinai
authors.forename: Takashi
authors.initials: T
authors.lastname: Inokuchi
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Matsuda
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Hidaka
authors.forename: Manabu
authors.initials: M
authors.lastname: Hayakawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Kangawa
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimada
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
mesh_terms: D052242:Adiponectin / Q000097:blood; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D016009:Chi-Square Distribution; D005260:Female; D054439:Ghrelin / Q000097:blood*; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D015415:Biomarkers; D054439:Ghrelin; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; C422650:ghrelin, des-n-octanoyl; D002097:C-Reactive Protein
keywords: blood pressure; cardiovascular disease; des-acyl ghrelin; geriatric; hypertension.