Serum Acylcarnitines and Risk of Cardiovascular Death and Acute Myocardial Infarction in Patients With Stable Angina Pectoris.
Excess levels of serum acylcarnitines, which are intermediate products in metabolism, have been observed in metabolic diseases such as type 2 diabetes mellitus. However, it is not known whether acylcarnitines may prospectively predict risk of cardiovascular death or acute myocardial infarction in patients with stable angina pectoris.



This study included 4164 patients (median age, 62 years; 72% men). Baseline serum acetyl-, octanoyl-, palmitoyl-, propionyl-, and (iso)valerylcarnitine were measured using liquid chromatography/tandem mass spectrometry. Hazard ratios (HRs) and 95% CIs for quartile 4 versus quartile 1 are reported. The multivariable model included age, sex, body mass index, fasting status, current smoking, diabetes mellitus, apolipoprotein A1, apolipoprotein B, creatinine, left ventricular ejection fraction, extent of coronary artery disease, study center, and intervention with folic acid or vitamin B6. During median 10.2 years of follow-up, 10.0% of the patients died of cardiovascular disease and 12.8% suffered a fatal or nonfatal acute myocardial infarction. Higher levels of the even-chained acetyl-, octanoyl-, and palmitoyl-carnitines were significantly associated with elevated risk of cardiovascular death, also after multivariable adjustments (HR [95% CI]: 1.52 [1.12, 2.06]; P=0.007; 1.73 [1.23, 2.44]; P=0.002; and 1.61 [1.18, 2.21]; P=0.003, respectively), whereas their associations with acute myocardial infarction were less consistent.



Among patients with suspected stable angina pectoris, elevated serum even-chained acylcarnitines were associated with increased risk of cardiovascular death and, to a lesser degree with acute myocardial infarction, independent of traditional risk factors.



URL: http://www.clinicaltrials.gov. Unique identifier: NCT00354081.
Department of Clinical Science, University of Bergen, Norway elin.strand@uib.no.
Elin
E
Strand
Department of Clinical Science, University of Bergen, Norway.
Eva R
ER
Pedersen
Department of Clinical Science, University of Bergen, Norway.
Gard F T
GF
Svingen
Department of Clinical Science, University of Bergen, Norway.|Department of Nutrition, University of Oslo, Norway.
Thomas
T
Olsen
Department of Clinical Science, University of Bergen, Norway.
Bodil
B
Bjørndal
Department of Clinical Science, University of Bergen, Norway.
Therese
T
Karlsson
Department of Clinical Medicine, University of Bergen, Norway.
Jutta
J
Dierkes
KG Jebsen Center for Diabetes Research, University of Bergen, Norway.|Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
Pål R
PR
Njølstad
Department of Clinical Science, University of Bergen, Norway.|KG Jebsen Center for Diabetes Research, University of Bergen, Norway.|Hormone Laboratory, Haukeland University Hospital, Bergen, Norway.
Gunnar
G
Mellgren
Department of Global Public Health and Primary Care, University of Bergen, Norway.|Division for Health Data and Digitalisation, Norwegian Institute of Public Health, Bergen, Norway.
Grethe S
GS
Tell
Department of Clinical Science, University of Bergen, Norway.|Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Rolf K
RK
Berge
Department of Clinical Science, University of Bergen, Norway.
Asbjørn
A
Svardal
Department of Clinical Science, University of Bergen, Norway.|KG Jebsen Center for Diabetes Research, University of Bergen, Norway.|Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Ottar
O
Nygård
D000368:Aged; D000787:Angina Pectoris / Q000097:blood* / Q000150:complications; D015415:Biomarkers / Q000097:blood; D002331:Carnitine / Q000031:analogs & derivatives* / Q000097:blood; D002423:Cause of Death / Q000639:trends; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000097:blood* / Q000209:etiology / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000209:etiology / Q000401:mortality; D009664:Norway / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
D015415:Biomarkers; C116917:acylcarnitine; D002331:Carnitine
acylcarnitines; angina pectoris; cardiovascular outcomes; metabolism