Plasma levels of CCL21, but not CCL19, independently predict future coronary events in a prospective population-based cohort

Background and aims: The homeostatic chemokines CCL21 and CCL19 have been explored as biomarkers in cardiovascular disease prediction in patients with established cardiovascular disease, but associations between these chemokines and first-time coronary event incidence have not been investigated before. Here, we explored associations between CCL21 or CCL19 and first-time incident coronary events in the general population-based Malmo spacing diaeresis Diet and Cancer cohort with two decades of follow-up.Methods: CCL21 and CCL19 levels in plasma were analysed with ELISA and proximity extension assay and as-sociations with disease incidence were explored with conditional logistic regression in a nested case-control cohort (CCL21; n = 676) and with Cox regression in a population-based cohort (CCL19; n = 4636).Results: High CCL21 levels in plasma were associated with incident first-time coronary events independently of traditional risk factors (odds ratio of 2.64 with 95% confidence interval 1.62-4.31, p < 0.001, comparing the highest versus the lowest tertile of CCL21), whereas CCL19 was not. CCL19 was, however, associated with incident heart failure, as well as increased all-cause, cardiovascular and cancer mortality independently of age and sex.Conclusions: Even though CCL21 and CCL19 both signal through CCR7, these chemokines may not be inter-changeable as disease predictors and CCL21 could be used for prediction of future coronary events in individuals without any previous coronary heart disease history.