title: ST2 may not be a useful predictor for incident cardiovascular events, heart failure and mortality.
abstract: OBJECTIVE
  We hypothesised that soluble ST2 (sST2) levels can identify people with elevated risk of subsequent cardiovascular disease (CVD) and add to existing risk prediction algorithms.
  
  
  BACKGROUND
  ST2 is a receptor for the inflammatory cytokine IL33. Increased sST2 levels have been associated with heart failure and death in acute myocardial infarction patients and in the general population.
  
  
  METHODS
  We measured high-sensitivity sST2 in 8444 men and women (25-74 years) from the FINRISK97 prospective population cohort. Cox proportional hazards modelling evaluated the ability of sST2 to predict fatal and non-fatal heart failure, CVD (coronary heart disease, stroke), diabetes, and death over 15 years follow-up. Discrimination and reclassification statistics for 10-year absolute risks compared the ability of sST2 to improve upon Framingham risk factors (FRF), N-terminal pro-brain natriuretic peptide (NT-proBNP), renal function (eGFR) and prevalent valvular heart disease (VHD).
  
  
  RESULTS
  sST2 showed suggestive but non-significant associations with heart failure {(HR per 1 SD of log sST2 1.06; 95% CI 0.96 to 1.17 (562 events))}, and with CVD (1.01 95% CI 0.94 to 1.08) (914 events) after adjustment for FRF, NT-proBNP, eGFR and VHD. sST2 significantly predicted death from all causes following similar adjustment ({HR 1.09 (95% CI 1.01 to 1.19) (974 events))}. No improvement in the c-index was observed for models adding sST2 to the risk factors.
  
  
  CONCLUSIONS
  In a healthy general population from Finland, sST2 did not improve long-term prediction of cardiovascular events including heart failure or all-cause mortality.
authors: Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany Centre of Excellence for Public Health Northern Ireland, Queens University Belfast, Belfast, UK MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
authors: Maria F
authors: MF
authors: Hughes
authors: Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany.
authors: Sebastian
authors: S
authors: Appelbaum
authors: Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
authors: Aki S
authors: AS
authors: Havulinna
authors: Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany.
authors: Annika
authors: A
authors: Jagodzinski
authors: Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany.
authors: Tanja
authors: T
authors: Zeller
authors: Centre of Excellence for Public Health Northern Ireland, Queens University Belfast, Belfast, UK.
authors: Frank
authors: F
authors: Kee
authors: Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany.
authors: Stefan
authors: S
authors: Blankenberg
authors: Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
authors: Veikko
authors: V
authors: Salomaa
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D005544:Forecasting; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D000072179:Interleukin-1 Receptor-Like 1 Protein; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011159:Population Surveillance / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors; D011956:Receptors, Cell Surface / Q000097:blood*; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate / Q000639:trends
chemical_list: C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D010446:Peptide Fragments; D011498:Protein Precursors; D011956:Receptors, Cell Surface; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: CORONARY ARTERY DISEASE; HEART FAILURE