School of Clinical Sciences, University of Bristol.
Department of Nephrology Medicine, University of Groningen and University Medical Center Groningen.
J Atheroscler Thromb. 2017 Aug 1;24(8):804-818. doi: 10.5551/jat.38836. Epub 2017 Feb 16.
Soluble cell adhesion molecules, such as vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1, E-selectin, and P-selectin, have been suggested to be associated with cardiovascular disease (CVD) risk; however, the nature and magnitude of the association between VCAM-1 and CVD risk is uncertain. We aimed to assess the association of VCAM-1 with CVD risk and determine its potential utility for CVD risk prediction.
VCAM-1 concentrations were measured at baseline in the PREVEND prospective study of 2,638 participants. Hazard ratios (95% confidence intervals [CI]) and measures of risk discrimination for CVD (e.g., C-index) and reclassification (i.e., net reclassification improvement) of participants were assessed.
During a median follow-up of 9.9 years, 614 CVD events occurred. Plasma VCAM-1 was weakly associated with several cardiovascular risk markers. In analyses adjusted for established cardiovascular risk factors, the hazard ratio (95% CI) for CVD per 1 standard deviation increase in log VCAM-1 was 0.91 (0.84-0.99; P =0.020), which remained consistent after additional adjustment for body mass index, alcohol consumption, triglycerides, renal function, and C-reactive protein; hazard ratio (95% CI) 0.89 (0.82-0.97; P =0.006). Comparing the top versus bottom quintiles of VCAM-1 levels, the corresponding adjusted hazard ratios were 0.74 (0.57-0.96; P =0.023) and 0.70 (0.54-0.91; P =0.007) respectively. Adding VCAM-1 to a CVD risk prediction model containing conventional risk factors did not improve the C-index or net reclassification.
Plasma VCAM-1 is inversely and independently associated with CVD. However, VCAM-1 provides no significant improvement in CVD risk assessment beyond conventional CVD risk factors.
血管细胞黏附分子-1（VCAM-1）、细胞间黏附分子-1、E-选择素和 P-选择素等可溶性细胞黏附分子已被认为与心血管疾病（CVD）风险相关；然而，VCAM-1 与 CVD 风险之间的关联性质和程度尚不确定。我们旨在评估 VCAM-1 与 CVD 风险的相关性，并确定其对 CVD 风险预测的潜在应用价值。
在 PREVEND 前瞻性研究中，对 2638 名参与者进行了基线 VCAM-1 浓度测量。评估了 CVD 风险的危害比（95%置信区间[CI]）和风险判别指标（如 C 指数），以及参与者的再分类（即净重新分类改善）。
在中位随访 9.9 年期间，发生了 614 例 CVD 事件。血浆 VCAM-1 与多种心血管风险标志物呈弱相关。在调整了已确立的心血管危险因素后，每增加 1 个 VCAM-1 对数标准差，CVD 的危害比（95%CI）为 0.91（0.84-0.99；P=0.020），在进一步调整体重指数、饮酒量、甘油三酯、肾功能和 C 反应蛋白后，这一比值保持不变；危害比（95%CI）为 0.89（0.82-0.97；P=0.006）。比较 VCAM-1 水平的最高五分位数与最低五分位数，相应的调整后危害比分别为 0.74（0.57-0.96；P=0.023）和 0.70（0.54-0.91；P=0.007）。将 VCAM-1 添加到包含传统危险因素的 CVD 风险预测模型中，并未提高 C 指数或净再分类。
血浆 VCAM-1 与 CVD 呈负相关且独立相关。然而，除了传统的 CVD 危险因素外，VCAM-1 对 CVD 风险评估没有显著改善。
