Related Experiment Video
Updated: Jun 29, 2025
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Associations between inflammatory and angiogenic proteomic biomarkers, and cardiovascular events and mortality in
Barbara Salzinger1, Kristina Lundwall2, Marie Evans3
1Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
Insights
Fibroblast growth factor 23 (FGF-23) is an independent prognostic marker in patients with acute coronary syndrome (ACS). FGF-23 levels predict major adverse cardiovascular events and death, regardless of chronic kidney disease (CKD) status.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Proteomics
Background:
- The relationship between chronic kidney disease (CKD) and cardiovascular disease (CVD) burden is not fully understood.
- Investigating inflammatory and angiogenic biomarkers in acute coronary syndrome (ACS) patients is crucial.
- Understanding how CKD influences these associations is key.
Purpose of the Study:
- To explore associations between biomarkers, kidney function, and outcomes in ACS patients.
- To determine if CKD status modifies the link between biomarkers and major adverse cardiovascular events plus death (MACE+).
Main Methods:
- 1293 ACS patients were followed for long-term outcomes.
- 13 pre-identified biomarkers were analyzed using proteomic methods.
- Cox regression models assessed biomarker associations with MACE+ and CKD interaction.
Main Results:
- Nine biomarkers showed inverse associations with kidney function.
- Endothelial cell-specific molecule-1 (ESM-1), FGF-23, and transmembrane immunoglobulin 1 (TIM-1) were linked to MACE+.
- Only FGF-23 remained independently associated with MACE+; no biomarkers interacted with CKD.
Conclusions:
- Nine of 13 biomarkers increased as kidney function declined.
- FGF-23 independently predicted MACE+ in ACS patients, irrespective of CKD.
- FGF-23 is a significant prognostic marker for ACS patients with or without CKD.
Background:
The links between chronic kidney disease (CKD) and the high burden of cardiovascular disease remain unclear. We aimed to explore the association between selected inflammatory and angiogenic biomarkers, kidney function and long-term outcome in patients with an acute coronary syndrome (ACS) and to test the hypothesis that CKD status modifies this association.
Methods:
A total of 1293 ACS patients hospitalized between 2008 and 2015 were followed until 31 December 2017. Plasma was collected on days 1-3 after admission. A total of 13 biomarkers were a priori identified and analysed with two proteomic methods, proximity extension assay or multiple reaction monitoring mass spectrometry. Boxplots and multiple linear regression models were used to study associations between biomarkers and kidney function and adjusted standardized Cox regression with an interaction term for CKD was used to assess whether CKD modified the association between biomarkers and major adverse cardiovascular events and death (MACE+).
Results:
The concentrations of nine biomarkers-endothelial cell-specific molecule-1 (ESM-1), fibroblast growth factor 23 (FGF-23), fractalkine (CX3CL1), interleukin-1 receptor antagonist (IL-1RA), interleukin-18 (IL-18), monocyte chemotactic protein-1 (MCP-1), placenta growth factor (PlGF), transmembrane immunoglobulin 1 (TIM-1) and vascular endothelial growth factor A (VEGFA)-were inversely associated with kidney function. ESM-1, FGF-23 and TIM-1 showed associations with MACE+. Only FGF23 remained independently associated after adjustment for the other biomarkers (hazard ratio per standard deviation increase 1.34; 95% Bonferroni corrected confidence interval 1.19-1.50). None of the biomarkers showed an interaction with CKD.
Conclusions:
The concentrations of 9 of the 13 prespecified inflammatory and angiogenic proteomic biomarkers increased when kidney function declined. Only FGF-23 demonstrated an independent association with MACE+, and this association was not modified by CKD status. These findings further support FGF-23 as an independent prognostic marker in ACS patients with and without CKD.
Related Concept Videos
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System