Novel biomarker shows promise for predicting all-cause death, stroke events
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Among Japanese outpatients with CV risk factors, the biomarker growth differentiation factor-15 was linked with increased risk for all-cause death and stroke events, researchers reported.
According to Keita Negishi, MD, of Jichi Medical University in Tochigi, Japan, and colleagues, growth differentiation factor-15 (GDF-15) has emerged as a biomarker for the prediction of all-cause death in community-dwelling individuals and patients with CVD.
For the nationwide prospective J-HOP study, Negishi and colleagues aimed to assess the prognostic value of GDF-15. They measured GDF-15 levels in 3,562 outpatients with CV risk factors, stratifying individuals into tertiles of GDF-15 and following up for all-cause death and CVD.
During a mean follow-up of 6.6 years, researchers reported 155 all-cause deaths; 81 stroke events, including cerebral infarction and intracranial hemorrhage; and 141 cardiac events, including CAD and HF.
After adjusting for traditional risk factors and other prognostic biomarkers, such as N-terminal pro-B-type natriuretic peptide (NT pro-BNP) and high-sensitivity troponin T, Negishi and colleagues found patients with higher GDF-15 levels were at increased risk for all-cause death and stroke events, but not cardiac events. Specifically, compared with patients in the lowest tertile, those in the highest tertile had a hazard ratio of 2.38 (95% CI, 1.26-4.48; P = .007) for all-cause death and 2.93 (95% CI, 1.31-6.56; P = .009) for stroke events.
In addition, the incorporation of GDF-15 into the predictive models for all-cause death significantly improved discrimination and reclassification, while for stroke events, GDF-15 demonstrated comparable diagnostic accuracy to NT pro-BNP and high-sensitivity troponin T.
“This study confirms that elevated [GDF-15] levels are associated with stroke events in Asian outpatients, independently of traditional risk factors and other specific prognostic biomarkers,” Negishi and colleagues wrote. “The relationship between GDF-15 and risks of cardiac events disappear after adjusting for traditional risk factors different from previous studies in the Western population.”
Going forward, the researchers noted that information about GDF-15 might be helpful for risk management of stroke events and all-cause death in outpatients with CV risk factors.
“However, it is difficult to make available GDF-15 to clinical practice individually because of its unique and complicated pathophysiology,” they wrote. “Recently, it was attempted to combine GDF-15 with other biomarkers for the risk management of CVD, which was incorporated in a new scoring system of bleeding risks for patients with atrial fibrillation. Thus, GDF-15 might be useful for clinical application of a multimarker strategy for stroke events in patients with cardiovascular risk factors.”
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