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Pregnancy Associated Plasma Protein-A as a Cardiovascular Risk Marker in Patients with Stable Coronary Heart Disease During 10 Years Follow-Up: A CLARICOR Trial Sub-Study
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Number of Authors: 152020 (English)In: Journal of clinical medicine, ISSN 2077-0383, Vol. 9, no 1, article id 265Article in journal (Refereed) Published
Abstract [en]

Elevated pregnancy-associated plasma protein A (PAPP-A) is associated with mortality in acute coronary syndromes. Few studies have assessed PAPP-A in stable coronary artery disease (CAD) and results are conflicting. We assessed the 10-year prognostic relevance of PAPP-A levels in stable CAD. The CLARICOR trial was a randomized controlled clinical trial including outpatients with stable CAD, randomized to clarithromycin versus placebo. The placebo group constituted our discovery cohort (n = 1.996) and the clarithromycin group the replication cohort (n = 1.975). The composite primary outcome was first occurrence of cardiovascular event or death. In the discovery cohort, incidence rates (IR) for the composite outcome were higher in those with elevated PAPP-A (IR 12.72, 95% Confidence Interval (CI) 11.0–14.7 events/100 years) compared to lower PAPP-A (IR 8.78, 8.25–9.34), with comparable results in the replication cohort. Elevated PAPP-A was associated with increased risk of the composite outcome in both cohorts (discovery Hazard Ratio (HR) 1.45, 95% CI 1.24–1.70; replication HR 1.29, 95% CI 1.10–1.52). In models adjusted for established risk factors, these trends were attenuated. Elevated PAPP-A was associated with higher all-cause mortality in both cohorts. We conclude that elevated PAPP-A levels are associated with increased long-term mortality in stable CAD, but do not improve long-term prediction of death or cardiovascular events when added to established predictors.

Place, publisher, year, edition, pages
2020. Vol. 9, no 1, article id 265
Keywords [en]
biomarkers, cohort studies, coronary artery disease, pregnancy-associated plasma protein-A
National Category
Clinical Medicine
Research subject
Health and Welfare
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URN: urn:nbn:se:du-31734DOI: 10.3390/jcm9010265ISI: 000515388400265PubMedID: 31963719OAI: oai:DiVA.org:du-31734DiVA, id: diva2:1388967
Available from: 2020-01-28 Created: 2020-01-28 Last updated: 2020-03-12Bibliographically approved

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Ärnlöv, Johan

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CiteExportLink to record
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Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • chicago-author-date
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  • Other style
More styles
Language
  • de-DE
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  • nn-NB
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Output format
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