Association of MR-proadrenomedullin with cardiovascular risk factors and subclinical cardiovascular disease


      • MR-proADM was measured in the general population.
      • We determined its association with CVRF and measures of subclinical CVD.
      • Elevated MR-proADM was strongly associated with CVRF and manifest CVD.
      • Association with echocardiographic measures of hypertension is gender-specific.


      Aims and background

      Midregional proadrenomedullin (MR-proADM) is a protein, which exerts various effects on the cardiovascular system. Recent studies underscored its prognostic implications in patients with acute dyspnea and cardiovascular diseases. Therefore, we aimed to determine the distribution of MR-proADM in the general population and to reveal potential associations of MR-proADM with cardiovascular risk factors and measures of subclinical cardiovascular disease.

      Methods and results

      MR-proADM plasma concentrations were determined in individuals of the population-based cohort of the Gutenberg Health Study (N = 5000) using a commercially available fluoroimmunoassay. Individuals were enrolled between April 2007 and October 2008. Subclinical cardiovascular disease was assessed using echocardiographic and functional measures of myocardial and vascular function. The mean age of the study population was 55.5 ± 10.9 years. In the overall population we determined a median MR-proADM plasma concentration of 0.44 nmol/L in men and women. MR-proADM concentrations were elevated in individuals with hypertension, diabetes, dyslipidemia, known cardiovascular disease, heart failure, peripheral artery disease, atrial fibrillation, and history of myocardial infarction and stroke. In men, we observed a positive association of MR-proADM with reduced ejection fraction, intraventricular septal diameter, wall thickness, and echocardiographic measures of diastolic dysfunction.


      In this study, we present age-dependent reference values for MR-proADM in a representative population sample. Elevated MR-proADM plasma concentrations were strongly associated with classical cardiovascular risk factors and manifest cardiovascular diseases. Furthermore, we revealed a gender-specific association with echocardiographic measures of hypertension. MR-proADM seems to be a promising prognostic biomarker for subclinical and manifest cardiovascular disease.



      CVD (cardiovascular disease), ADM (adrenomedullin), MR-proADM (midregional proadrenomedullin), LV (left ventricular), MI (myocardial infarction), NT-proBNP (n-terminal pro-brain natriuretic peptide), CVRF (cardiovascular risk factors), GHS (Gutenberg Health Study), CAD (coronary artery disease), ECG (electrocardiogram), LDL (low-density lipoprotein), HDL (high-density lipoprotein), BMI (body mass index), NYHA (New York Heart Association), EDTA (ethylenediaminetetraacetic acid), EF (ejection fraction), IVSD (intraventricular septal diameter), IMT (intima-media-thickness), FMD (flow-mediated dilation), PAT (peripheral artery tone), SD (standard deviation), eGFR (estimated glomerular filtration rate), AF (atrial fibrillation), BP (blood pressure), CRP (c-reactive protein), ACC (A. carotis communis/common carotid artery), MV (mitral valve), CI (confidence interval), DDPEF (diastolic dysfunction with preserved ejection fraction), SHFNDF (systolic heart failure with normal diastolic function), HFPEF (heart failure with preserved ejection fraction), PDFREF (preserved diastolic function with reduced ejection fraction)
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