title: Midregional proadrenomedullin and its change predicts recurrent major coronary events and heart failure in stable coronary heart disease patients: the LIPID study.
abstract: BACKGROUND
  Biomarkers may contribute to risk stratification in coronary heart disease (CHD). We examined whether plasma midregional proadrenomedullin (MR-proADM) concentration at baseline and its change over one year predicts long-term outcomes in stable CHD patients.
  
  
  METHODS
  The LIPID study randomised patients 3-36 months after an acute coronary syndrome with total cholesterol 4.0-7.0 mmol/L (155-271 mg/dL), to placebo or pravastatin 40 mg. Follow-up was 6.0 years. MR-proADM plasma concentrations at baseline and one year later were determined in 7863 and 6658 patients, respectively. These were categorised into quartiles to perform Cox regression analysis, adjusting for baseline parameters.
  
  
  RESULTS
  Baseline MR-proADM concentrations predicted major CHD events (non-fatal myocardial infarction or CHD death; hazard ratio (HR) 1.52, 1.26-1.84 for Q4-Q1), CHD death (HR 2.21, 1.67-2.92), heart failure (HR 2.30, 1.78-2.97) and all-cause mortality (HR 1.82, 1.49-2.23). Associations were still significant after adjustment for baseline B-type natriuretic peptide (BNP) concentration. Increase in MR-proADM after one year was associated with increased risk of subsequent CHD events (HR 1.34, 1.08-1.66), non-fatal myocardial infarction (HR 1.50, 1.12-2.03), heart failure (HR 1.78, 1.37-2.30) and all-cause mortality (HR 1.31, 1.04-1.64). Associations with heart failure and all-cause mortality remained significant after adjusting for baseline and change in BNP concentration. Change in MR-proADM moderately improved risk reclassification for major CHD events (net reclassification improvement (NRI) 3.48%) but strongly improved risk reclassification for heart failure (NRI 5.60%).
  
  
  CONCLUSIONS
  Baseline and change in MR-proADM concentrations over one year are associated with risk of major clinical events, even after adjustment for BNP concentrations.
authors: Hamburg University Heart Center, Germany.
authors: Anne
authors: A
authors: Funke-Kaiser
authors: University of Sydney, Australia.
authors: Kristy
authors: K
authors: Mann
authors: The Wesley Hospital, Brisbane, Australia.
authors: David
authors: D
authors: Colquhoun
authors: Hamburg University Heart Center, Germany.
authors: Tanja
authors: T
authors: Zeller
authors: Monash University, Melbourne, Australia.
authors: David
authors: D
authors: Hunt
authors: University of Sydney, Australia.
authors: John
authors: J
authors: Simes
authors: University of Sydney, Australia.
authors: David
authors: D
authors: Sullivan
authors: Hamburg University Heart Center, Germany.
authors: Karsten
authors: K
authors: Sydow
authors: University of Queensland, Australia.
authors: Malcolm
authors: M
authors: West
authors: Green Lane Cardiovascular Service, Auckland, New Zealand.
authors: Harvey
authors: H
authors: White
authors: Hamburg University Heart Center, Germany.
authors: Stefan
authors: S
authors: Blankenberg
authors: Monash University, Melbourne, Australia. Electronic address: Andrew.Tonkin@monash.edu.
authors: Andrew M
authors: AM
authors: Tonkin
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003327:Coronary Disease / Q000097:blood* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D017035:Pravastatin / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D012008:Recurrence; D018570:Risk Assessment
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011498:Protein Precursors; C088633:proadrenomedullin; D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin; D017035:Pravastatin
keywords: Biomarker; Coronary heart disease; Heart failure; LIPID study; Midregional proadrenomedullin; Risk factors