Banerjee Shreya, Garimella Pranav S, Hong Kimberly N, Bullen Alexander L, Daniels Lori B, Wettersten Nicholas
Department of Medicine, University of California, 9500 Gilman Drive, UC, La Jolla, San Diego, CA 92037, USA.
Division of Nephrology-Hypertension, University of California, 9300 Campus Point Drive #7424 La Jolla, San Diego, CA 92037, USA.
Int J Cardiol Heart Vasc. 2024 Nov 16;55:101557. doi: 10.1016/j.ijcha.2024.101557. eCollection 2024 Dec.
Proenkephalin (PENK) is a novel biomarker of kidney function associated with cardiovascular risk in patients with cardiovascular disease. Its association with cardiovascular outcomes in ambulatory individuals is less described. In an observational study of 199 ambulatory Veterans enrolled from April to September 2010, we assessed PENK's association with major adverse cardiac events (MACE - cardiovascular death, heart failure [HF] hospitalization, myocardial infarction [MI], or stroke) and individual outcomes of all-cause mortality, incident HF, and cardiovascular death using Cox regression. We also assessed the association of PENK with left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and left ventricular mass index (LVMi) with linear regression. The mean age was 66 ± 12 years, 99 % were men, and 76 % were White, with median follow-up of 12.7 years. Each two-fold higher PENK was associated with a 73 % higher risk of MACE in unadjusted analysis (HR 1.73; 95 % CI 1.00, 2.99; p = 0.043), though this association lost significance after adjusting for confounders (HR 1.69; 95 % CI 0.90-3.15; p = 0.098). PENK was not associated with all-cause mortality, incident HF or cardiovascular death, although risk estimates were elevated with wide confidence intervals for incident HF and cardiovascular death. PENK was not associated with LVMi or LVEDd but had a non-linear relationship with LVEF with low and high PENK associated with lower LVEF. In conclusion, PENK may be associated with a higher risk of MACE in ambulatory Veterans with diverse health statuses; however, further studies are needed. Abbreviations: PENK: Proenkephalin A; MACE: Major Adverse Cardiac Events.
前脑啡肽原（PENK）是一种与心血管疾病患者心血管风险相关的新型肾功能生物标志物。其与非卧床个体心血管结局的关联描述较少。在一项对2010年4月至9月招募的199名非卧床退伍军人的观察性研究中，我们使用Cox回归评估了PENK与主要不良心脏事件（MACE，即心血管死亡、心力衰竭[HF]住院、心肌梗死[MI]或中风）以及全因死亡率、新发HF和心血管死亡的个体结局之间的关联。我们还使用线性回归评估了PENK与左心室射血分数（LVEF）、左心室舒张末期直径（LVEDd）和左心室质量指数（LVMi）之间的关联。平均年龄为66±12岁，99%为男性，76%为白人，中位随访时间为12.7年。在未调整分析中，PENK每升高两倍与MACE风险升高73%相关（风险比[HR]1.73；95%置信区间[CI]1.00，2.99；p = 0.043），不过在调整混杂因素后这种关联失去显著性（HR 1.69；95% CI 0.90 - 3.15；p = 0.098）。PENK与全因死亡率、新发HF或心血管死亡无关，尽管新发HF和心血管死亡的风险估计值升高且置信区间较宽。PENK与LVMi或LVEDd无关，但与LVEF呈非线性关系，PENK水平低和高时均与较低的LVEF相关。总之，PENK可能与健康状况各异的非卧床退伍军人发生MACE的较高风险相关；然而，还需要进一步研究。缩写：PENK：前脑啡肽原A；MACE：主要不良心脏事件
