Abstract
BackgroundCirculating microRNAs (miRNAs) have been described as potential diagnostic biomarkers in cardiovascular disease and in particular, coronary artery disease (CAD). Few studies were undertaken to perform analyses with regard to risk stratification of future cardiovascular events. miR-126, miR-197 and miR-223 are involved in endovascular inflammation and platelet activation and have been described as biomarkers in the diagnosis of CAD. They were identified in a prospective study in relation to future myocardial infarction.ObjectivesThe aim of our study was to further evaluate the prognostic value of these miRNAs in a large prospective cohort of patients with documented CAD.MethodsLevels of miR-126, miR-197 and miR-223 were evaluated in serum samples of 873 CAD patients with respect to the endpoint cardiovascular death. miRNA quantification was performed using real time polymerase chain reaction (RT-qPCR).ResultsThe median follow-up period was 4 years (IQR 2.78–5.04). The median age of all patients was 64 years (IQR 57–69) with 80.2% males. 38.9% of the patients presented with acute coronary syndrome (ACS), 61.1% were diagnosed with stable angina pectoris (SAP). Elevated levels of miRNA-197 and miRNA-223 reliably predicted future cardiovascular death in the overall group (miRNA-197: hazard ratio (HR) 1.77 per one standard deviation (SD) increase (95% confidence interval (CI) 1.20; 2.60), p = 0.004, C-index 0.78; miRNA-223: HR 2.23 per one SD increase (1.20; 4.14), p = 0.011, C-index 0.80). In ACS patients the prognostic power of both miRNAs was even higher (miRNA-197: HR 2.24 per one SD increase (1.25; 4.01), p = 0.006, C-index 0.89); miRA-223: HR 4.94 per one SD increase (1.42; 17.20), p = 0.012, C-index 0.89).ConclusionSerum-derived circulating miRNA-197 and miRNA-223 were identified as predictors for cardiovascular death in a large patient cohort with CAD. These results reinforce the assumption that circulating miRNAs are promising biomarkers with prognostic value with respect to future cardiovascular events.
Highlights
In cardiovascular pathologies circulating miRNAs have been described as disease-specific biomarkers [1,2,3,4,5,6,7] and various animal models and clinical studies have proven miRNAs suitable for diagnostic purposes in coronary artery disease (CAD) and myocardial infarction (MI) [2, 8,9,10,11,12,13,14]
The median age of all patients was 64 years (IQR 57–69) with 80.2% males. 38.9% of the patients presented with acute coronary syndrome (ACS), 61.1% were diagnosed with stable angina pectoris (SAP)
Platelet-derived miR-197 levels are associated with thrombocyte activation and were found altered in patients receiving anti-platelet therapy [22], while miR197 was dysregulated in patients with type 2 diabetes mellitus [23] indicating a potential role of this miRNA in CAD disease progression
Summary
In cardiovascular pathologies circulating miRNAs have been described as disease-specific biomarkers [1,2,3,4,5,6,7] and various animal models and clinical studies have proven miRNAs suitable for diagnostic purposes in coronary artery disease (CAD) and myocardial infarction (MI) [2, 8,9,10,11,12,13,14]. MiR-126, miR-197 and miR-223 are involved in endovascular inflammation and platelet activation and have been described as biomarkers in the diagnosis of CAD. They were identified in a prospective study in relation to future myocardial infarction
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