Aims
Decreased arylesterase (ArylE) activity of paraoxonase-1, a HDL-associated protein with anti-inflammatory and antioxidant properties, has been associated with increased risk of cardiac events in patients with ischemic heart failure (HF). We aim to investigate the prognostic significance of changes in serum ArylE activity over time.
Methods and results
We examined the association between baseline and follow up serum ArylE activity and HF outcomes (death, cardiac transplantation or ventricular assist device implantation) in 299 patients with HF enrolled in a prospective cohort study from 1/2008 to 7/2009, with 145 patients have available follow up levels at 1 year. A significant drop in ArylE activity on follow up was defined as a drop of ≥25% vs. baseline levels. Mean baseline and follow up ArylE activity levels were 110.5±29.8µmol/min/ml and 106.2±29.9µmol/min/ml, respectively. After mean follow up of 2.8±1.1 years, low baseline ArylE activity was associated with increased risk of adverse HF events [HR (lowest vs highest tertile)=2.6(95% CI 1.3–5.5), p=0.01] and HF related hospitalization [incidence rate ratio (lowest vs highest tertile)=2.1(95%CI 1.2–4.1), p=0.016], which remained significant after adjustment for age, male, systolic blood pressure, diabetes, creatinine clearance, coronary artery disease, and HDL Cholesterol levels. Patients who had a significant drop in ArylE activity on follow up (≥25% of baseline levels, n=18), had significantly increased risk of HF events [HR=4.9(95%CI 1.6–14.6), p=0.005], even after adjustment for baseline levels of ArylE activity.
Conclusions
Reduced baseline ArylE activity and decreased levels on follow up are associated with adverse outcomes in stable outpatients with HF.