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Serum Sortilin Is Associated with Coronary Artery Calcification and Cardiovascular and Cerebrovascular Events in
Jie Xu1, Chan-Juan Shen2, Joshua D Ooi3
1Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China.
Insights
Serum sortilin is a newly identified independent risk factor for coronary artery calcification (CAC) and cardiovascular and cerebrovascular events (CCE) in patients undergoing maintenance hemodialysis (MHD). Higher sortilin levels predict adverse outcomes in this high-risk population.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Biochemistry
Background:
- Maintenance hemodialysis (MHD) patients face a high risk of cardiovascular and cerebrovascular events (CCE).
- Coronary artery calcification (CAC) is a common complication in MHD patients, contributing to increased morbidity and mortality.
- The role of specific biomarkers like sortilin in predicting these outcomes in MHD patients remains under investigation.
Purpose of the Study:
- To investigate the association between serum sortilin levels and the presence and severity of CAC in MHD patients.
- To determine if serum sortilin is an independent predictor of CCE in MHD patients.
- To evaluate the potential of serum sortilin as a biomarker for cardiovascular risk stratification in this population.
Main Methods:
- A cohort of 111 MHD patients (dialysis duration ≥3 months) was studied.
- General, clinical, hematological data, and medication history were collected.
- Coronary artery calcification (CAC) was assessed using imaging techniques, and patients were followed for a median of 45 months for cardiovascular and cerebrovascular events (CCE).
Main Results:
- 60% of MHD patients exhibited varying degrees of CAC.
- Serum sortilin, diabetes, and calcium-phosphorus product were identified as independent risk factors for CAC.
- Serum sortilin, diabetes mellitus, and CAC were independently associated with an increased risk of CCE, with a serum sortilin cutoff of 418 pg/mL showing predictive value.
Conclusions:
- Serum sortilin is a novel, independent risk factor associated with both CAC and CCE in MHD patients.
- These findings suggest that serum sortilin may serve as a valuable biomarker for assessing cardiovascular risk in MHD patients.
- Targeting sortilin or managing factors associated with its elevation could potentially mitigate cardiovascular risk in this vulnerable group.
Objective:
To analyze the role of serum sortilin in coronary artery calcification (CAC) and cardiovascular and cerebrovascular events (CCE) in maintenance hemodialysis (MHD) patients.
Methods:
One hundred eleven patients with MHD ≥3 months were included in this study. The general data, clinical features, hematological data, and medication history of the patients were recorded. Eighty-five cases were examined by vascular color Doppler ultrasound, cardiac color Doppler ultrasound, lateral lumbar radiography, and coronary artery calcification score. The patients were followed up for a median time of 45 months. The primary endpoint was CCE or death from a vascular event, and the role of sortilin in this process was analyzed.
Results:
Among 85 MHD patients, 51 cases (60.00%) had different degrees of CAC. There were significant differences in diabetes, dialysis time, serum phosphorus, calcium-phosphorus product, medical history of phosphate binders, sortilin, and carotid artery plaque between 4 different degrees of calcification groups (p < 0.05). Logistic regression analysis showed that diabetes (OR = 5.475; 95% CI: 1.794-16.71, p = 0.003), calcium-phosphorus product (OR = 2.953; 95% CI: 1.198-7.279, p = 0.019), and sortilin (OR = 1.475 per 100 pg/mL; 95% CI: 1.170-1.858, p = 0.001) were independent risk factors for CAC. During the follow-up, 28 cases of 111 patients (25.23%) suffered from CCE. There were significant differences in CCE between mild, moderate, and severe CAC groups and noncalcification groups (p < 0.05). Cox regression analysis showed that diabetes mellitus (HR 3.424; 95% CI: 1.348-8.701, p = 0.010), CAC (HR 5.210; 95% CI: 1.093-24.83, p = 0.038), and serum sortilin (HR = 8.588; 95% CI: 1.919-38.43, p = 0.005) were independent risk factors for CCE. Besides, we proposed a cutoff value of 418 pg/mL for serum sortilin level, which was able to predict the occurrence of CCE with 75.0% sensitivity and 71.9% specificity. The area under the curve was 0.778 (95% CI: 0.673-0.883).
Conclusion:
Sortilin is newly found to be independently associated with CAC and CCE in MHD patients.
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