Moissl Angela P, Delgado Graciela E, Scharnagl Hubert, Siekmeier Rüdiger, Krämer Bernhard K, Duerschmied Daniel, März Winfried, Kleber Marcus E
Department of Medicine I (Cardiology, Hemostaseology, Medical Intensive Care), Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
LURIC Study gGmbH, Josef-Mörtl-Straße 23, 86482 Aystetten, Germany.
Int J Mol Sci. 2025 Jul 29;26(15):7335. doi: 10.3390/ijms26157335.
Inflammatory biomarkers, including high-sensitivity C-reactive protein (hsCRP), serum amyloid A (SAA), and interleukin-6 (IL-6), have been associated with an increased risk of future cardiovascular events. While they provide valuable prognostic information, these associations do not necessarily imply a direct causal role. The combined prognostic utility of these markers, however, remains insufficiently studied. We analysed 3300 well-characterised participants of the Ludwigshafen Risk and Cardiovascular Health (LURIC) study, all of whom underwent coronary angiography. Participants were stratified based on their serum concentrations of hsCRP, SAA, and IL-6. Associations between biomarker combinations and mortality were assessed using multivariate Cox regression and ROC analysis. Individuals with elevated hsCRP and SAA or IL-6 showed higher prevalence rates of coronary artery disease, heart failure, and adverse metabolic traits. These "both high" groups had lower estimated glomerular filtration rate, higher NT-proBNP, and increased HbA1c. Combined elevations of hsCRP and SAA were significantly associated with higher all-cause and cardiovascular mortality in partially adjusted models. However, these associations weakened after adjusting for IL-6. IL-6 alone demonstrated the highest predictive power (AUC: 0.638) and improved risk discrimination when included in multi-marker models. The co-elevation of hsCRP, SAA, and IL-6 identifies a high-risk phenotype characterised by greater cardiometabolic burden and increased mortality. IL-6 may reflect upstream inflammatory activity and could serve as a therapeutic target. Multi-marker inflammatory profiling holds promise for refining cardiovascular risk prediction and advancing personalised prevention strategies.
炎症生物标志物,包括高敏C反应蛋白(hsCRP)、血清淀粉样蛋白A(SAA)和白细胞介素-6(IL-6),与未来心血管事件风险增加相关。虽然它们提供了有价值的预后信息,但这些关联并不一定意味着存在直接因果关系。然而,这些标志物的联合预后效用仍未得到充分研究。我们分析了路德维希港风险与心血管健康(LURIC)研究中3300名特征明确的参与者,他们均接受了冠状动脉造影。参与者根据其hsCRP、SAA和IL-6的血清浓度进行分层。使用多变量Cox回归和ROC分析评估生物标志物组合与死亡率之间的关联。hsCRP、SAA或IL-6升高的个体患冠状动脉疾病、心力衰竭和不良代谢特征的患病率更高。这些“双高”组的估计肾小球滤过率较低、NT-proBNP较高且糖化血红蛋白(HbA1c)升高。在部分调整模型中,hsCRP和SAA的联合升高与全因死亡率和心血管死亡率显著相关。然而,在调整IL-6后,这些关联减弱。单独的IL-6显示出最高的预测能力(AUC:0.638),并且在多标志物模型中纳入时可改善风险辨别能力。hsCRP、SAA和IL-6的共同升高确定了一种高风险表型,其特征是更大的心脏代谢负担和死亡率增加。IL-6可能反映上游炎症活动,并可作为治疗靶点。多标志物炎症分析有望改善心血管风险预测并推进个性化预防策略。
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