title: The association between serum cathepsin L and mortality in older adults.
abstract: Research suggests that the protease cathepsin L is causally involved in atherosclerosis. However, data on cathepsin L as a risk marker are lacking. Therefore, we investigated associations between circulating cathepsin L and cardiovascular mortality.
  
  
  
  Two independent community-based cohorts were used: Uppsala Longitudinal Study of Adult Men (ULSAM); n = 776; mean age 77 years; baseline 1997-2001; 185 cardiovascular deaths during 9.7 years follow-up, and Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS); n = 993; 50% women; mean age 70 years; baseline 2001-2004; 42 cardiovascular deaths during 10.0 years follow-up.
  
  
  
  Higher serum cathepsin L was associated with an increased risk for cardiovascular mortality in age- and sex-adjusted models in both cohorts (ULSAM: hazard ratio (HR) for 1-standard deviation (SD) increase, 1.17 [95% CI, 1.01-1.34], p = 0.032 PIVUS: HR 1.35 [95% CI, 1.07-1.72], p = 0.013). When merging the cohorts, these associations were independent of inflammatory markers and cardiovascular risk factors, but non-significant adjusting for kidney function. Individuals with a combination of elevated cathepsin L and increased inflammation, kidney dysfunction, or prevalent cardiovascular disease had a markedly increased risk, while no increased risk was associated with elevated cathepsin L, in the absence of these disease states.
  
  
  
  An association between higher serum cathepsin L and increased risk of cardiovascular mortality was found in two independent cohorts. Impaired kidney function appears to be an important moderator or mediator of these associations. Further studies are needed to delineate the underlying mechanisms and to evaluate whether the measurement of cathepsin L might have clinical utility.
authors.affiliation: School of Health and Social Studies, Dalarna University, Falun, Sweden; Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Tobias
authors.initials: T
authors.lastname: Feldreich
authors.affiliation: Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Axel C
authors.initials: AC
authors.lastname: Carlsson
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Risérus
authors.affiliation: Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Larsson
authors.affiliation: Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Lind
authors.affiliation: School of Health and Social Studies, Dalarna University, Falun, Sweden; Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden. Electronic address: johan.arnlov@medsci.uu.se.
authors.forename: Johan
authors.initials: J
authors.lastname: Ärnlöv
mesh_terms: D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D056668:Cathepsin L / Q000097:blood*; D005260:Female; D006801:Humans; D007249:Inflammation; D007674:Kidney Diseases / Q000097:blood*; D007677:Kidney Function Tests; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D012737:Sex Factors; D013548:Sweden
chemical_list: D056668:Cathepsin L
keywords: Atherosclerosis; Cardiovascular; Cathepsin; Epidemiology; Mortality; Population based studies