GDF-15 for prognostication of cardiovascular and cancer morbidity and mortality in men

PLoS One. 2013 Dec 2;8(12):e78797. doi: 10.1371/journal.pone.0078797. eCollection 2013.

Abstract

The objective was to evaluate the hypothesis that growth-differentiation factor 15 (GDF-15) is an independent marker of the long-term risk for both cardiovascular disease and cancer morbidity beyond clinical and biochemical risk factors. Plasma obtained at age 71 was available from 940 subjects in the Uppsala Longitudinal Study of Adult Men (ULSAM) cohort. Complete mortality and morbidity data were obtained from public registries. At baseline there were independent associations between GDF-15 and current smoking, diabetes mellitus, biomarkers of cardiac (high-sensitivity troponin-T, NT-proBNP) and renal dysfunction (cystatin-C) and inflammatory activity (C-reactive protein), and previous cardiovascular disease (CVD). During 10 years follow-up there occurred 265 and 131 deaths, 115 and 46 cardiovascular deaths, and 185 and 86 events with coronary heart disease mortality or morbidity in the respective total cohort (n=940) and non-CVD (n=561) cohort. After adjustment for conventional cardiovascular risk factors, one SD increase in log GDF-15 were, in the respective total and non-CVD populations, associated with 48% (95%CI 26 to 73%, p<0.001) and 67% (95%CI 28 to 217%, p<0.001) incremental risk of cardiovascular mortality, 48% (95%CI 33 to 67%, p<0.001) and 61% (95%CI 38 to 89%, p<0.001) of total mortality and 36% (95%CI 19 to 56%, p<0.001) and 44% (95%CI 17 to 76%, p<0.001) of coronary heart disease morbidity and mortality. The corresponding incremental increase for cancer mortality in the respective total and non-cancer disease (n=882) population was 46% (95%CI 21 to 77%, p<0.001) and 38% (95%CI 12 to 70%, p<0.001) and for cancer morbidity and mortality in patients without previous cancer disease 30% (95%CI 12 to 51%, p<0.001). In conclusion, in elderly men, GDF-15 improves prognostication of both cardiovascular, cancer mortality and morbidity beyond established risk factors and biomarkers of cardiac, renal dysfunction and inflammation.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers, Tumor / blood*
  • Cardiovascular Diseases / blood*
  • Cardiovascular Diseases / mortality*
  • Disease-Free Survival
  • Follow-Up Studies
  • Growth Differentiation Factor 15 / blood*
  • Humans
  • Male
  • Neoplasms / blood*
  • Neoplasms / mortality*
  • Retrospective Studies
  • Risk Factors
  • Survival Rate

Substances

  • Biomarkers, Tumor
  • GDF15 protein, human
  • Growth Differentiation Factor 15

Grants and funding

The study was supported by an unrestricted grant from the Swedish Heart Foundation. Roche Diagnostics, Germany, provided the GDF-15 assay. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.