Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece.
Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
J Am Coll Cardiol. 2015 Mar 10;65(9):904-16. doi: 10.1016/j.jacc.2014.12.035.
The amyloid beta peptide is the major protein constituent of neuritic plaques in Alzheimer disease and appears to play a central role in vascular inflammation pathophysiology.
This study sought to determine the clinical value of amyloid-beta 1-40 (Abeta40) measurement in predicting cardiovascular (CV) mortality in patients with coronary heart disease (CHD) and arterial stiffness progression in young healthy subjects.
Abeta40 was retrospectively measured in blood samples collected from 3 independent prospective cohorts and 2 case-control cohorts (total N = 1,464). Major adverse cardiac events (MACE) were assessed in the 2 prospective cohorts (n = 877) followed for a median of 4.4 years. To look at effects on subclinical disease, arterial stiffness was evaluated at baseline and after 5-year follow-up (n = 107) in young healthy subjects. The primary endpoint was the predictive value of Abeta40 for CV mortality and outcomes in patients with CHD.
In Cox proportional hazards models adjusted for age, sex, estimated glomerular filtration rate, left ventricular ejection fraction, high-sensitivity C-reactive protein, and high-sensitivity troponin T, Abeta40 independently predicted CV death and MACE in patients with CHD (p < 0.05 for all). After multivariate adjustment, Abeta40 levels conferred a substantial enhancement of net reclassification index and integrated discrimination improvement of individuals at risk in the total combined CHD cohort over the best predictive model. Further cohort-based analysis revealed that Abeta40 levels were significantly and independently associated with arterial stiffness progression, incident subclinical atherosclerosis, and incident CHD.
Measuring blood levels of Abeta40 identified patients at high risk for CV death.
淀粉样β肽是阿尔茨海默病中神经原纤维缠结的主要蛋白质成分，似乎在血管炎症发病机制中起核心作用。
本研究旨在确定测定β淀粉样肽 1-40（Abeta40）在预测冠心病（CHD）患者心血管（CV）死亡率和年轻健康受试者动脉僵硬度进展方面的临床价值。
回顾性测量了来自 3 个独立前瞻性队列和 2 个病例对照队列（共 1464 人）的血液样本中的 Abeta40。在随访中位数为 4.4 年的 2 个前瞻性队列中评估了主要不良心脏事件（MACE）（n=877）。为了观察亚临床疾病的影响，在年轻健康受试者中基线和 5 年随访后评估了动脉僵硬度（n=107）。主要终点是 Abeta40 对 CHD 患者 CV 死亡率和结局的预测价值。
在调整年龄、性别、估计肾小球滤过率、左心室射血分数、高敏 C 反应蛋白和高敏肌钙蛋白 T 后，Cox 比例风险模型显示 Abeta40 独立预测 CHD 患者的 CV 死亡和 MACE（所有 p<0.05）。经过多变量调整后，Abeta40 水平使高危个体的净重新分类指数和综合鉴别改善指数在总合并 CHD 队列中显著提高，超过了最佳预测模型。进一步的基于队列的分析表明，Abeta40 水平与动脉僵硬度进展、亚临床动脉粥样硬化和 CHD 事件显著且独立相关。
测量 Abeta40 的血液水平可识别出 CV 死亡率高的患者。
