Related Experiment Video
Updated: Jun 3, 2025
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Prediction of Major Adverse Cardiovascular Events in Patients with Peripheral Artery Disease Using Circulating
Ben Li1,2,3,4, Farah Shaikh2, Houssam Younes5
1Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada.
Insights
Elevated levels of galectin-1, galectin-9, and alpha-1-microglobulin predict major adverse cardiovascular events (MACE) in peripheral artery disease (PAD) patients. These immunomodulatory proteins can help stratify risk and guide treatment for better cardiovascular outcomes.
Area of Science:
- Cardiovascular Medicine
- Biomarker Discovery
- Immunology
Background:
- Major adverse cardiovascular events (MACE) are the primary cause of mortality in peripheral artery disease (PAD) patients.
- Limited research exists on predictive biomarkers for MACE in PAD.
- Immunomodulatory proteins influence atherosclerosis and may serve as prognostic indicators for MACE in PAD.
Purpose of the Study:
- To evaluate a panel of immunomodulatory proteins for their association with MACE in PAD patients.
- To identify specific proteins that can predict MACE risk in individuals with PAD.
Main Methods:
- A prospective prognostic study of 406 patients (254 with PAD, 152 without PAD) was conducted.
- Plasma concentrations of 17 immunomodulatory proteins were measured at baseline.
- The cohort was followed for two years to assess MACE (myocardial infarction, stroke, or death) using Cox proportional hazards and Kaplan-Meier analyses.
Main Results:
- Galectin-1, alpha-1-microglobulin, and galectin-9 were significantly elevated in PAD patients who experienced MACE.
- These three proteins were independently associated with 2-year MACE after adjusting for clinical factors.
- Higher levels of these proteins correlated with a lower freedom from MACE in PAD patients, with no significant association in non-PAD patients.
Conclusions:
- Galectin-1, galectin-9, and alpha-1-microglobulin are independently and specifically associated with MACE in PAD.
- Plasma concentrations of these proteins can aid in risk stratification for MACE in PAD patients.
- This finding can inform clinical decisions for multidisciplinary referrals and guide aggressive medical management to improve cardiovascular outcomes.
Abstract:
Background/Objectives: The leading cause of death for people with peripheral artery disease (PAD) is major adverse cardiovascular events (MACE), including heart attacks and strokes. However, research into biomarkers that could help predict MACE in patients with PAD has been limited. Immunomodulatory proteins are known to significantly influence systemic atherosclerosis, suggesting they could be useful prognostic indicators for MACE in patients with PAD. In this study, we evaluated a broad panel of immunomodulatory proteins to identify those linked to MACE in individuals with PAD. Methods: We conducted a prognostic study involving a prospectively recruited cohort of 406 patients consisting of 254 with PAD and 152 without PAD. At the baseline, we measured the plasma concentrations of 17 circulating immunomodulatory proteins and followed the cohort for two years. The primary outcome was 2-year MACE, a composite of myocardial infarction, stroke, or death. Plasma protein concentrations were compared between patients with PAD with and without 2-year MACE using Mann-Whitney U tests. We further examined the prognostic potential of differentially expressed proteins through a Cox proportional hazards analysis, determining their independent associations with 2-year MACE while controlling for all the baseline demographic and clinical characteristics, including the existing coronary artery and cerebrovascular diseases. Additionally, A Kaplan-Meier analysis was performed to evaluate the 2-year freedom from MACE in patients with low versus high levels of the differentially expressed proteins based on the median plasma concentrations. Results: The mean age of the cohort was 68.8 years (SD 11.1), with 134 patients (33%) being female. During the two-year follow-up, 63 individuals (16%) developed MACE. The following proteins were significantly elevated in patients with PAD who experienced 2-year MACE compared to those who did not: galectin-1 (0.17 [SD 0.06] vs. 0.10 [SD 0.07] pg/mL, p = 0.012), alpha-1-microglobulin (16.68 [SD 7.48] vs. 14.74 [SD 6.71] pg/mL, p = 0.019), and galectin-9 (0.14 [SD 0.09] vs. 0.09 [SD 0.05] pg/mL, p = 0.033). The Cox proportional hazards analysis indicated that these three proteins were independently associated with 2-year MACE after adjusting for all the baseline demographic and clinical factors: galectin-1 (HR 1.45 [95% CI 1.09-1.92], p = 0.019), alpha-1-microglobulin (HR 1.31 [95% CI 1.06-1.63], p = 0.013), and galectin-9 (HR 1.35 [95% CI 1.02-1.78], p = 0.028). Over the two-year follow-up, patients with higher levels of galectin-1, galectin-9, and alpha-1-microglobulin had a lower freedom from MACE. Additional analysis showed that these three proteins were not significantly associated with 2-year MACE in patients without PAD. Conclusions: Among the 17 immunomodulatory proteins evaluated, galectin-1, galectin-9, and alpha-1-microglobulin were found to be independently and specifically associated with 2-year MACE in patients with PAD. Assessing the plasma concentrations of these proteins can aid in risk stratification for MACE in patients with PAD, helping to inform clinical decisions regarding multidisciplinary referrals to cardiologists, neurologists, and vascular medicine specialists. This information can also guide the aggressiveness of medical management, ultimately improving cardiovascular outcomes for patients with PAD.
