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Elevated plasma endothelin-1 levels may predict poor outcomes in black adults
Black adults with elevated plasma endothelin-1 levels and pulmonary hypertension have a higher risk for mortality and hospital admission for HF, researchers reported in JAMA Cardiology.
Using data from the Jackson Heart Study, the researchers investigated the relationship between plasma endothelin-1 levels with pulmonary hypertension, mortality and HF admissions in 3,223 black adults (33% men) living in Jackson, Mississippi.
The main exposure was plasma endothelin-1 levels. The primary outcomes were mortality and HF-related hospital admission.
The findings confirmed that log-transformed endothelin-1 levels have a strong association with pulmonary hypertension. According to the researchers, the adjusted OR for pulmonary hypertension per log increment of endothelin-1 levels was 1.66 (95% CI, 1.16-2.37). Sensitivity analyses showed that pulmonary hypertension was more prevalent in participants with high endothelin-1 levels (11.2%) than in those with low levels (5.3%).
During follow-up, 289 deaths were reported, with more deaths occurring in the high endothelin-1 levels group than in the low-level group. During a median follow-up of 7.75 years, elevated log-endothelin-1 levels were associated with mortality (adjusted HR per log increment = 1.69; 95% CI, 1.27-2.25).
In addition, 148 patients were admitted to the hospital with decompensated HF and, during a median follow-up of 5.32 years, log-endothelin-1 levels were significantly associated with HF events (adjusted HR per log increment = 1.57; 95% CI, 1.05-2.37). However, that significance did not remain after adjustments were made for left atrial diameter index (HR = 1.35; 95% CI, 0.91-2.05), pulmonary hypertension (HR = 1.35; 95% CI, 0.9-2.02) or log-transformed pulmonary artery systolic pressure (HR = 1.37; 95% CI, 0.91-2.05).
“In studying a cohort from the community setting, with a lower prevalence of advanced disease states, we may have identified a risk marker for a subpopulation in which preventive interventions focused on the [endothelin-1 levels] pathway may be more efficacious. However, this can only be determined through carefully designed future clinical studies,” the researchers wrote. – by Tracey Romero
Disclosure: One researcher reports receiving investigator-initiated grant support from Novartis.