title: Which biomarkers are predictive specifically for cardiovascular or for non-cardiovascular mortality in men? Evidence from the Caerphilly Prospective Study (CaPS).
abstract: OBJECTIVE
  To examine a panel of 28 biomarkers for prediction of cardiovascular disease (CVD) and non-CVD mortality in a population-based cohort of men.
  
  
  METHODS
  Starting in 1979, middle-aged men in Caerphilly underwent detailed medical examination. Subsequently 2171 men were re-examined during 1989-1993, and fasting blood samples obtained from 1911 men (88%). Fibrinogen, viscosity and white cell count (WCC), routine biochemistry tests and lipids were analysed using fresh samples. Stored aliquots were later analysed for novel biomarkers. Statistical analysis of CVD and non-CVD mortality follow-up used competing risk Cox regression models with biomarkers in thirds tested at the 1% significance level after covariate adjustment.
  
  
  RESULTS
  During an average of 15.4 years follow-up, troponin (subhazard ratio per third 1.71, 95% CI 1.46-1.99) and B-natriuretic peptide (BNP) (subhazard ratio per third 1.54, 95% CI 1.34-1.78) showed strong trends with CVD death but not with non-CVD death. WCC and fibrinogen showed similar weaker findings. Plasma viscosity, growth differentiation factor 15 (GDF-15) and interleukin-6 (IL-6) were associated positively with both CVD death and non-CVD death while total cholesterol was associated positively with CVD death but negatively with non-CVD death. C-reactive protein (C-RP), alkaline phosphatase, gamma-glutamyltransferase (GGT), retinol binding protein 4 (RBP-4) and vitamin B6 were significantly associated only with non-CVD death, the last two negatively. Troponin, BNP and IL-6 showed evidence of diminishing associations with CVD mortality through follow-up.
  
  
  CONCLUSIONS
  Biomarkers for cardiac necrosis were strong, specific predictors of CVD mortality while many inflammatory markers were equally predictive of non-CVD mortality.
authors: Centre for Public Health, Queen's University Belfast, Belfast, UK.
authors: Christopher C
authors: CC
authors: Patterson
authors: University Heart Centre Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany.
authors: Stefan
authors: S
authors: Blankenberg
authors: Social and Community Medicine, University of Bristol, UK.
authors: Yoav
authors: Y
authors: Ben-Shlomo
authors: Institute of Primary Care & Public Health, Cardiff University School of Medicine, Cardiff, UK.
authors: Luke
authors: L
authors: Heslop
authors: Institute of Primary Care & Public Health, Cardiff University School of Medicine, Cardiff, UK.
authors: Antony
authors: A
authors: Bayer
authors: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors: Gordon
authors: G
authors: Lowe
authors: University Heart Centre Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany.
authors: Tanja
authors: T
authors: Zeller
authors: Department of Psychiatry, Warneford Hospital, Oxford, UK.
authors: John
authors: J
authors: Gallacher
authors: Centre for Public Health, Queen's University Belfast, Belfast, UK.
authors: Ian
authors: I
authors: Young
authors: Centre for Public Health, Queen's University Belfast, Belfast, UK. Electronic address: j.yarnell@qub.ac.uk.
authors: John
authors: J
authors: Yarnell
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D014852:Wales / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators
keywords: Biomarkers; Cardiovascular mortality; Epidemiology; Non-cardiovascular mortality