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INTERLEUKIN-6 AND C-REACTIVE PROTEIN AND RISK FOR DEATH AND CARDIOVASCULAR EVENTS IN PATIENTS WITH ATRIAL FIBRILLATION
- 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.
- Subjects :
- Male
medicine.medical_specialty
Myocardial Infarction
Hemorrhage
Risk Assessment
Predictive Value of Tests
Thromboembolism
Internal medicine
Atrial Fibrillation
medicine
Humans
In patient
Myocardial infarction
Interleukin 6
Stroke
Aged
Proportional Hazards Models
Framingham Risk Score
biology
Interleukin-6
business.industry
C-reactive protein
Warfarin
Anticoagulants
Atrial fibrillation
Prognosis
medicine.disease
Troponin
Dabigatran
C-Reactive Protein
biology.protein
Cardiology
Female
Myocardial infarction diagnosis
business
Cardiology and Cardiovascular Medicine
Biomarkers
medicine.drug
Subjects
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