High serum immunoglobulin g and m levels predict freedom from adverse cardiovascular events in hypertension: a nested case-control substudy of the Anglo-Scandinavian cardiac outcomes trial

Khamis, R. Y. et al. (2016) High serum immunoglobulin g and m levels predict freedom from adverse cardiovascular events in hypertension: a nested case-control substudy of the Anglo-Scandinavian cardiac outcomes trial. EBioMedicine, 9, pp. 372-380. (doi:10.1016/j.ebiom.2016.06.012) (PMID:27333022) (PMCID:PMC4972545)

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Abstract

Aims: We aimed to determine whether the levels of total serum IgM and IgG, together with specific antibodies against malondialdehyde-conjugated low-density lipoprotein (MDA-LDL), can improve cardiovascular risk discrimination. Methods and Results: The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) randomized 9098 patients in the UK and Ireland into the Blood Pressure-Lowering Arm. 485 patients that had cardiovascular (CV) events over 5.5 years were age and sex matched with 1367 controls. Higher baseline total serum IgG, and to a lesser extent IgM, were associated with decreased risk of CV events (IgG odds ratio (OR) per one standard deviation (SD) 0.80 [95% confidence interval, CI 0.72,0.89], p < 0.0001; IgM 0.83[0.75,0.93], p = 0.001), and particularly events due to coronary heart disease (CHD) (IgG OR 0.66 (0.57,0.76); p < 0.0001, IgM OR 0.81 (0.71,0.93); p = 0.002). The association persisted after adjustment for a basic model with variables in the Framingham Risk Score (FRS) as well as following inclusion of C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (NtProBNP). IgG and IgM antibodies against MDA-LDL were also associated with CV events but their significance was lost following adjustment for total serum IgG and IgM respectively. The area under the receiver operator curve for CV events was improved from the basic risk model when adding in total serum IgG, and there was improvement in continuous and categorical net reclassification (17.6% and 7.5% respectively) as well as in the integrated discrimination index. Conclusion: High total serum IgG levels are an independent predictor of freedom from adverse cardiovascular events, particularly those attributed to CHD, in patients with hypertension.

Item Type:Articles
Additional Information:The work was funded by a grant from the National Institute for Health Research Comprehensive Biomedical Research Centre (RDB02_P46385) at Imperial College Healthcare NHS Trust. The parent ASCOT study was an independent, investigator-initiated, investigator-designed, and investigator-led study funded by a grant program from Pfizer UK. DH receives BHF Professorial Support. CK is supported by Japan Heart Foundation/Bayer Yakuhin Research Grant Abroad. RYK was funded as a Wellcome Trust Clinical Research Fellow. DOH has professorial support from the British Heart Foundation. JJB acknowledges the British Heart Foundation SCRF03 for his financial support. The original ASCOT study was supported by an investigational grant from Pfizer International, New York, NY, USA. The principal funding source for ASCOT was Pfizer, New York, NY, USA. Servier Research Group, Paris, France, and Leo Laboratories, Copenhagen, Denmark provided additional funding.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Welsh, Dr Paul and Sattar, Professor Naveed
Authors: Khamis, R. Y., Hughes, A. D., Caga-Anan, M., Chang, C. L., Boyle, J. J., Kojima, C., Welsh, P., Sattar, N., Johns, M., Sever, P., Mayet, J., and Haskard, D. O.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:EBioMedicine
Publisher:Elsevier
ISSN:2352-3964
ISSN (Online):2352-3964
Published Online:20 June 2016
Copyright Holders:Copyright © 2016 The Authors
First Published:First published in EBioMedicine 9: 372-380
Publisher Policy:Reproduced under a Creative Commons License

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