title: Cotinine as a marker for risk prediction in the Ludwigshafen Risk and Cardiovascular Health Study.
abstract: BACKGROUND
  Cotinine is one of the major metabolites of nicotine. The aim our study was to investigate cotinine as a marker for individual risk prediction in the Ludwigshafen Risk and Cardiovascular Health study.
  
  
  METHODS
  840 samples had detectable cotinine measured using a radioimmunoassay (RIA nicotine metabolite, DPC Biermann GmbH). The distribution of risk factors across quartiles of cotinine or pack-years was analyzed by ANOVA and the association of cotinine and pack-years with mortality by Cox regression.
  
  
  RESULTS
  Cotinine and pack-years both showed significant association with mortality in adjusted models with HRs (95% CI) of 1.30 (1.17-1.44) and 1.26 (1.13-1.42) comparing the third to the first tertile for cotinine and pack-years, respectively. Either cotinine or pack-years or self-reported smoking increased the area-under-the-curve significantly as compared to a basic model including other risk factors.
  
  
  CONCLUSIONS
  Cotinine is a strong predictor of mortality in non-smokers as well as in smokers. As objectively measurable parameter cotinine would be preferable for risk prediction.
authors.affiliation: Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Graciela
authors.initials: G
authors.lastname: Delgado
authors.affiliation: Drug Regulatory Affairs, Pharmaceutical Institute, Bonn University, Bonn, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Siekmeier
authors.affiliation: Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Bernhard K
authors.initials: BK
authors.lastname: Krämer
authors.affiliation: Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany; Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria; Synlab Academy, Synlab Services GmbH, Mannheim, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: März
authors.affiliation: Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany. Electronic address: Marcus.kleber@medma.uni-heidelberg.de.
authors.forename: Marcus E
authors.initials: ME
authors.lastname: Kleber
mesh_terms: D019540:Area Under Curve; D015415:Biomarkers / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism* / Q000401:mortality*; D003367:Cotinine / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012907:Smoking / Q000378:metabolism* / Q000401:mortality*; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D003367:Cotinine
keywords: Cotinine; Mortality; Nicotine; Smoking