Objective-Inflammation plays a key role in atherosclerosis. We hypothesized that novel inflammatory markers may predict the risk of coronary heart disease (CHD). Approach and Results-We investigated the association of 16 inflammatory biomarkers with the risk of CHD in a random subset of 839 CHD-free individuals in a prospective population-based cohort study. A Bonferroni corrected P value of 3.1×10 −3 was used as a threshold of statistical significance. The mean age at baseline was 72.8 years. During a median follow-up of 10.6 years, 99 cases of incident CHD were observed. Among all inflammatory biomarkers, neutrophilderived human s100a12 (extracellular newly identified receptor for advanced glycation end-products binding protein [EN-RAGE]) showed the strongest association with the risk of CHD (P value 2.0×10 −3 ). After multivariable adjustment for established cardiovascular risk factors, each standard deviation increase in the natural log-transformed EN-RAGE was associated with 30% higher risk of incident CHD (hazard ratio, 1.30; 95% confidence interval, 1.06-1.59). Further adjustment for previously studied inflammatory markers did not attenuate the association. Excluding individuals with prevalent type 2 diabetes mellitus, impaired kidney function, or individuals using antihypertensive medication did not change the effect estimates. Cause-specific hazard ratios suggested a stronger association between EN-RAGE and CHD mortality compared with stable CHD. Additional adjustment for previously studied inflammatory markers yielded slightly increased effect estimates (Table 2; Table IV in the online-only Data Supplement). Cumulative incidence curves for the tertiles of EN-RAGE adjusted for competing risks are depicted in Figure 2. The 10-year probability of first incident event of CHD was 0.05 (95% CI, 0.03-0.08) for the first tertile, 0.11 (95% CI, 0.07-0.14) for the second tertile, and 0.14 (95% CI, 0.10-0.18) for the third tertile.
Conclusions-Our results highlight EN-RAGE as an inflammatoryAfter excluding participants with chronic kidney disease at baseline, the association between EN-RAGE and incident CHD attenuated slightly (1.28; 95% CI, 1.03-1.59; Table 3). Excluding participants with type 2 diabetes mellitus, the effect estimates of the association between EN-RAGE and CHD did not change: hazard ratio 1.29 (95% CI, 1.04-1.60) in the fully adjusted model. Finally, after excluding participants taking antihypertensive medication, the hazard ratio did not change (HR, 1.40; 95% CI, 1.05-1.87). ).
DiscussionIn this prospective, population-based cohort study, we found that higher EN-RAGE levels were associated with an increased risk of CHD beyond conventional risk factors. Further adjustments for inflammatory markers, as well as excluding diseased individuals, did not change the results. These findings suggest proinflammatory EN-RAGE as a new inflammatory risk marker for CHD that represents a distinct inflammatory pathway compared with other inflammatory markers.Previous studies have observed increased levels of E...