Biomarkers of residual risk and all-cause mortality after acute coronary syndrome.
Background: Adverse cardiovascular events often recur after acute coronary syndrome (ACS), despite secondary prevention measures. Residual risk involves various inflammatory, metabolic and renal factors as well as lipid and thrombotic processes. This cohort study investigates the relationship betwee...
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Elsevier
2025-03-01
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| Series: | American Journal of Preventive Cardiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666667725000078 |
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| author | Anna Toso Mario Leoncini Mauro Maioli Simona Villani Francesco Bellandi |
| author_facet | Anna Toso Mario Leoncini Mauro Maioli Simona Villani Francesco Bellandi |
| author_sort | Anna Toso |
| collection | DOAJ |
| description | Background: Adverse cardiovascular events often recur after acute coronary syndrome (ACS), despite secondary prevention measures. Residual risk involves various inflammatory, metabolic and renal factors as well as lipid and thrombotic processes. This cohort study investigates the relationship between four risk biomarkers at 1 month after ACS and all-cause death within 3 years in patients treated with early invasive strategy and high-intensity statins from admission. Methods: Levels of residual risk for the biomarkers were: low-density lipoprotein cholesterol (LDL-C) ≥ 70 mg/dl; high-sensitivity C reactive protein (hs-CRP) ≥ 2 mg/l; glycosylated hemoglobin (HbA1c) ≥ 7% in diabetic and ≥ 5.7% in non-diabetic patients; decrease in estimated glomerular filtration rate (eGFR) ≥ 25% compared to baseline. The association between the four biomarkers and all-cause death within 3 years was evaluated with Cox proportional analysis. Results: This study included 1099 patients (68±12 years; 70.3% males). At 1 month the majority of patients had levels of LDL-C, hs-CRP and/or HbA1c above the risk cut-points, and only 7% of cases presented reduced eGFR. Reduced eGFR and hs-CRP ≥ 2 mg/l at 1 month were the sole independent biomarker predictors of 3-year mortality (adjusted hazard ratios 3.03 and 2.66, respectively). Conclusions: In this population on high-intensity statin therapy only hsCRP and eGFR were independently associated with medium-term mortality. Diversification of secondary preventive measures based on routine evaluations of inflammation and kidney function markers, not only LDL-C, could lead to better targeted reduction of residual risk after ACS. |
| format | Article |
| id | doaj-art-2369312bfa434e58bfbc1682ebdd854d |
| institution | Kabale University |
| issn | 2666-6677 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Preventive Cardiology |
| spelling | doaj-art-2369312bfa434e58bfbc1682ebdd854d2025-01-19T06:26:45ZengElsevierAmerican Journal of Preventive Cardiology2666-66772025-03-0121100934Biomarkers of residual risk and all-cause mortality after acute coronary syndrome.Anna Toso0Mario Leoncini1Mauro Maioli2Simona Villani3Francesco Bellandi4Cardiology Unit, Department of Medical Specialties, Azienda USL Toscana Centro, Prato, Italy; Correspondence author at: Cardiology Unit, Santo Stefano Hospital, Via suor Niccolina infermiera, 20, Prato, Italy.Cardiology Unit, Department of Medical Specialties, Azienda USL Toscana Centro, Prato, ItalyCardiology Unit, Department of Medical Specialties, Azienda USL Toscana Centro, Prato, ItalySection of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, Pavia University, Pavia, ItalyCardiology Unit, Department of Medical Specialties, Azienda USL Toscana Centro, Prato, ItalyBackground: Adverse cardiovascular events often recur after acute coronary syndrome (ACS), despite secondary prevention measures. Residual risk involves various inflammatory, metabolic and renal factors as well as lipid and thrombotic processes. This cohort study investigates the relationship between four risk biomarkers at 1 month after ACS and all-cause death within 3 years in patients treated with early invasive strategy and high-intensity statins from admission. Methods: Levels of residual risk for the biomarkers were: low-density lipoprotein cholesterol (LDL-C) ≥ 70 mg/dl; high-sensitivity C reactive protein (hs-CRP) ≥ 2 mg/l; glycosylated hemoglobin (HbA1c) ≥ 7% in diabetic and ≥ 5.7% in non-diabetic patients; decrease in estimated glomerular filtration rate (eGFR) ≥ 25% compared to baseline. The association between the four biomarkers and all-cause death within 3 years was evaluated with Cox proportional analysis. Results: This study included 1099 patients (68±12 years; 70.3% males). At 1 month the majority of patients had levels of LDL-C, hs-CRP and/or HbA1c above the risk cut-points, and only 7% of cases presented reduced eGFR. Reduced eGFR and hs-CRP ≥ 2 mg/l at 1 month were the sole independent biomarker predictors of 3-year mortality (adjusted hazard ratios 3.03 and 2.66, respectively). Conclusions: In this population on high-intensity statin therapy only hsCRP and eGFR were independently associated with medium-term mortality. Diversification of secondary preventive measures based on routine evaluations of inflammation and kidney function markers, not only LDL-C, could lead to better targeted reduction of residual risk after ACS.http://www.sciencedirect.com/science/article/pii/S2666667725000078Residual cardiovascular riskAcute coronary syndromeLDL cholesterolC-reactive proteinGlycated hemoglobinWorsening renal function |
| spellingShingle | Anna Toso Mario Leoncini Mauro Maioli Simona Villani Francesco Bellandi Biomarkers of residual risk and all-cause mortality after acute coronary syndrome. American Journal of Preventive Cardiology Residual cardiovascular risk Acute coronary syndrome LDL cholesterol C-reactive protein Glycated hemoglobin Worsening renal function |
| title | Biomarkers of residual risk and all-cause mortality after acute coronary syndrome. |
| title_full | Biomarkers of residual risk and all-cause mortality after acute coronary syndrome. |
| title_fullStr | Biomarkers of residual risk and all-cause mortality after acute coronary syndrome. |
| title_full_unstemmed | Biomarkers of residual risk and all-cause mortality after acute coronary syndrome. |
| title_short | Biomarkers of residual risk and all-cause mortality after acute coronary syndrome. |
| title_sort | biomarkers of residual risk and all cause mortality after acute coronary syndrome |
| topic | Residual cardiovascular risk Acute coronary syndrome LDL cholesterol C-reactive protein Glycated hemoglobin Worsening renal function |
| url | http://www.sciencedirect.com/science/article/pii/S2666667725000078 |
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