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Plasma Ceramides and Cardiovascular Events in Hypertensive Patients at High Cardiovascular Risk
Wenjie Yin1,2,3,4, Fengjuan Li3,4, Xin Tan3,4
1Key Laboratory of Cellular Physiology, Ministry of Education, and the Department of Physiology, Shanxi Medical University, Taiyuan, Shanxi Province, China.
Insights
Plasma ceramides predict cardiovascular events in hypertensive patients. A novel ceramide score (CERT-HBP) improves risk prediction, aiding in identifying high-risk individuals for targeted therapy.
Area of Science:
- Biochemistry
- Cardiovascular Medicine
- Clinical Chemistry
Background:
- Plasma ceramides (Cer) are established biomarkers for cardiovascular (CV) event risk in coronary heart disease patients.
- The utility of ceramides and ceramide scores (CERT) for CV risk stratification in hypertensive individuals remains to be fully elucidated.
Purpose of the Study:
- To investigate the performance of specific plasma ceramides and a novel ceramide score in predicting major adverse cardiovascular events (MACE) among hypertensive patients at high CV risk.
Main Methods:
- Ultra-performance liquid chromatography-tandem mass spectrometry was used to analyze seven ceramides in 920 essential hypertension patients.
- Patients were followed for a median of 2.3 years to record MACE, including acute coronary syndrome, heart failure, stroke, and CV death.
Main Results:
- Three ceramides, Cer(d18:1/16:0), Cer(d18:1/22:0), and Cer(d18:1/24:0), demonstrated significant predictive value for MACE.
- A novel ceramide score for hypertensive patients (CERT-HBP), incorporating specific ceramides and their ratios, significantly improved the C-statistic from 0.751 to 0.791 (P = 0.010), outperforming traditional risk variables.
Conclusions:
- A ceramide-based CERT-HBP was developed and validated for evaluating MACE risk in high-risk hypertensive patients.
- This novel score enhances the identification of patients who may benefit from intensified monitoring and aggressive treatment strategies.
Background:
Plasma ceramides (Cer) have been used to evaluate risk of cardiovascular (CV) events in patients with coronary heart disease. We investigated the performance of ceramides and ceramide score (CERT) in hypertensive patients at high CV risk.
Methods:
Seven ceramides were analyzed using ultra-performance liquid chromatography-tandem mass spectrometry in 920 essential hypertension patients at high CV risk, who visited Beijing Anzhen Hospital from September 2016 to September 2018 (median age: 49 years, 562 males). All patients were followed up for major adverse cardiovascular events (MACE), which included incident acute coronary syndrome, heart failure, stroke, and CV death.
Results:
During mean 2.3-year follow-up, 71 patients experienced MACE. Cer(d18:1/16:0), Cer(d18:1/22:0), and Cer(d18:1/24:0) were highly significant in predicting MACE [multiadjusted hazard ratios (95% confidence interval, CI) per SD were 1.76 (1.34-2.30), 0.55 (0.41-0.73), and 0.66 (0.47-0.92), respectively]. Compared with traditional variables (comprising presence of CV risk factors, hypertension-mediated organ damage, and comorbidities), a novel CERT for hypertensive patients (CERT-HBP), composed of Cer(d18:1/16:0), Cer(d18:1/24:1), and their ratios to Cer(d18:1/24:0) and Cer(d18:1/22:0), respectively, increased the C-statistic from 0.751 (95% CI, 0.697-0.806) to 0.791 (95% CI, 0.737-0.845), P = 0.010. Net reclassification improvement and integrated discrimination improvement were 0.648 (95% CI, 0.421-0.885, P < 0.001) and 0.046 (95% CI, 0.025-0.068, P < 0.001), respectively.
Conclusions:
A ceramide-based CERT-HBP was established to evaluate risk of MACE in hypertensive patients at high CV risk. This may improve identification of high-risk patients requiring increased attention and aggressive therapy.
Clinical Trials Registration:
Trial Number NCT03708601.
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