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Hvidovre Hospital - en del af Københavns Universitetshospital

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

Publikation: Bidrag til tidsskriftTidsskriftartikelpeer review


  • Erik Nilsson
  • Jens Kastrup
  • Ahmad Sajadieh
  • Gorm Boje Jensen
  • Erik Kjøller
  • Hans Jørn Kolmos
  • Jonas Wuopio
  • Christoph Nowak
  • Anders Larsson
  • Janus Christian Jakobsen
  • Per Winkel
  • Christian Gluud
  • Kasper K Iversen
  • Johan Ärnlöv
  • Axel C Carlsson
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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.

TidsskriftJournal of Clinical Medicine
Udgave nummer1
StatusUdgivet - 18 jan. 2020

ID: 59121220