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European Heart Journal Advance Access published online on March 6, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp049
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

High serum YKL-40 concentration is associated with cardiovascular and all-cause mortality in patients with stable coronary artery disease

Jens Kastrup1,*,{dagger}, Julia S. Johansen2,{dagger}, Per Winkel3, Jørgen Fischer Hansen4, Per Hildebrandt5, Gorm Boje Jensen6, Christian M. Jespersen4, Erik Kjøller7, Hans Jørn Kolmos8, Inga Lind9, Henrik Nielsen10, Christian Gluud3 and the CLARICOR Trial Group

1 Department of Medicine B, Cardiac Catheterization Laboratory 2014, The Heart Centre, Rigshospitalet, Copenhagen University Hospital and Faculty of Health Sciences, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
2 Department of Rheumatology, Copenhagen University Hospital, Copenhagen, Denmark
3 The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
4 Department of Cardiology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
5 Department of Cardiology, Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
6 Department of Cardiology, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
7 Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
8 Department of Clinical Microbiology, Odense University Hospital, Denmark
9 Statens Serum Institute, Copenhagen, Denmark
10 Department of Cardiology, Amager Hospital, Copenhagen University Hospital, Copenhagen, Denmark

Received 4 July 2008; revised 29 December 2008; accepted 16 January 2009 * Corresponding author. Tel: +45 35 45 28 19/28 17, Fax: +45 35 45 27 05, Email: jens.kastrup{at}rh.regionh.dk

Aims: Macrophages in atherosclerotic plaques secrete YKL-40. We tested the hypothesis if high serum YKL-40 concentration predicts coronary events and death of patients with stable coronary artery disease (CAD).

Methods and results: During the 2.6 years follow-up period (median 2.77 year, interquartile range 0.23 year), 270 patients among the 4298 patients with stable CAD in the CLARICOR trial suffered myocardial infarction (MI) and 377 died (187 classified as cardiovascular death). Serum YKL-40 transformed as Y=log[max(82, serum YKL-40/µg/L)] was significantly associated with cardiovascular death [hazard ratio (HR) = 1.88, 95% confidence interval (CI) = 1.54–2.31, P < 0.001], all-cause mortality (HR = 2.01, 95% CI = 1.75–2.31, P < 0.001), and MI (HR = 1.38, 95% CI = 1.13–1.68, P = 0.002). Following multivariable adjustment for cardiovascular risk factors (age, sex, previous MI, smoking status, hypertension, diabetes mellitus) and selected medical treatments Y contributed significantly to prediction of all-cause mortality (P < 0.001) and cardiovascular mortality (P = 0.001), but not MI (P = 0.25).

Conclusion: High serum YKL-40 is associated with MI, cardiovascular and all-cause mortality in patients with stable CAD.

Key Words: Biomarker • Coronary artery disease • Heart disease • Prognostic factors • YKL-40

{dagger} These authors contributed equally to this article.


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