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INTERLEUKIN-6 AND C-REACTIVE PROTEIN AND RISK FOR DEATH AND CARDIOVASCULAR EVENTS IN PATIENTS WITH ATRIAL FIBRILLATION

Authors :
Salim Yusuf
Stuart J. Connolly
Paul A. Reilly
Julia Aulin
Ulrika Andersson
Agneta Siegbahn
Jonas Oldgren
Kurt Huber
Michael D. Ezekowitz
Lars Wallentin
Source :
Journal of the American College of Cardiology. 57(14)
Publication Year :
2011
Publisher :
Elsevier BV, 2011.

Abstract

Inflammation has been associated with cardiovascular disease and the burden of atrial fibrillation (AF). In this study we evaluate inflammatory biomarkers and future cardiovascular events in AF patients in the RE-LY study.Interleukin-6 (IL-6), C-reactive protein (CRP) (n = 6,187), and fibrinogen (n = 4,893) were analyzed at randomization; outcomes were evaluated by Cox models and C-statistics.Adjusted for clinical risk factors IL-6 was independently associated with stroke or systemic embolism (P = .0041), major bleedings (P = .0001), vascular death (P.0001), and a composite thromboembolic outcome (ischemic stroke, systemic embolism, myocardial infarction, pulmonary embolism and vascular death) (P.0001). CRP was independently related to myocardial infarction (P = .0047), vascular death (P = .0004), and the composite thromboembolic outcome (P = .0001). When further adjusted for cardiac (troponin and N-terminal fragment B-type natriuretic peptide [NT-proBNP]) and renal (cystatin-C) biomarkers on top of clinical risk factors IL-6 remained significantly related to vascular death (P.0001), major bleeding (P.0170) and the composite thromboembolic outcome (P.0001), and CRP to myocardial infarction (.0104). Fibrinogen was not associated with any outcome. C-index for stroke or systemic embolism increased from 0.615 to 0.642 (P = .0017) when adding IL-6 to the clinically used CHA2DS2-VASc risk score with net reclassification improvement of 28%.In patients with AF, IL-6 is related to higher risk of stroke and major bleeding, and both markers are related to higher risk of vascular death and the composite of thromboembolic events independent of clinical risk factors. Adjustment for cardiovascular biomarkers attenuated the prognostic value, although IL-6 remained related to mortality, the composite of thromboembolic events, and major bleeding, and CRP to myocardial infarction.

Details

ISSN :
07351097
Volume :
57
Issue :
14
Database :
OpenAIRE
Journal :
Journal of the American College of Cardiology
Accession number :
edsair.doi.dedup.....6ae348ba0a189068c7c5fcb88f6139de
Full Text :
https://doi.org/10.1016/s0735-1097(11)60091-0