miRNAs may improve risk prediction in CAD

By Laura Cowen

Single microRNAs (miRNAs) derived from peripheral blood predict cardiovascular mortality in patients with coronary artery disease (CAD), German research shows.

These findings indicate that miRNAs "represent valuable biomarkers for risk estimation in CAD", Tanja Zeller (University Heart Center Hamburg) and co-authors remark in the European Heart Journal.

Zeller and team report that seven of eight miRNAs, previously identified as markers of unstable angina pectoris, predicted cardiovascular mortality in 1112 patients with CAD who participated in the AtheroGene study.

During a median follow-up of 4.0 years, 43 (10%) of the 430 patients with acute coronary syndromes (ACS) and 35 (5%) of the 682 patients with stable angina pectoris experienced cardiovascular death or nonfatal myocardial infarction.

In the patients with ACS, serum concentrations of miR-19a, miR-19b, miR-132, miR-140-3p, miR-150, miR-186 and miR-210 were all independently associated with a significantly increased risk of cardiovascular death, at hazard ratios ranging from 2.08 to 3.59 per standard deviation increase. And these associations remained significant after adjustment for cardiovascular risk factors such as left ventricular ejection fraction, number of diseased vessels and type of ACS diagnosis.

The only miRNA not associated with outcome in this group was miR-142-5p.

The researchers also found that circulating miR-132, miR-140-3p and miR-210 improved the performance of predictive models by 5-7% with areas under the receiver-operating characteristic curve (ROC) of 0.737, 0.756 and 0.754, respectively.

In the overall cohort, five of eight circulating miRNAs (miR-19b, miR-132, miR-140-3p, miR-150 and miR-186) independently predicted cardiovascular death at hazard ratios between of 1.56 and 2.19, and miR-140-3p in particular was associated with improvements in the performance of predictive models with an area under the ROC of 0.725.

In an accompanying editorial, Donato Santovito and Christian Weber, from Ludwig-Maximilians-University Munich in Germany say the study data "suggest that the time for miRNAs to move from laboratory bench into clinical use as biomarkers is coming closer."

If the "impressive discriminatory power" of circulating miRNAs shown here can be replicated, they may play a "leading role... in refining future cardiovascular risk algorithms", Santovito and Weber remark.

They conclude: "Eventually, this might convey a powerful tool to cardiologist to fulfil the unmet need of optimizing risk prediction in secondary prevention with the ultimate goal of further improving management and prognosis in those patients."

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