Association between blood biomarkers and adverse cardiovascular and kidney outcomes
openNHLBI - National Heart Lung and Blood Institute
Project Abstract
Kidney Disease is prevalent in people with hypertension and is associated with adverse cardiovascular (CV)
outcomes. Knowledge regarding circulating biomarkers for early detection of which patients with hypertension
are at future risk for decline in glomerular filtration rate (eGFR) and adverse heart outcomes is limited. Evidence
from clinical trials clearly demonstrated that effective blood pressure (BP) lowering treatment ameliorates the
harmful effects of uncontrolled hypertension on adverse kidney and heart outcomes; yet, it remains unclear in
which individuals intensive BP lowering will result in further GFR decline, and guidelines regarding BP target in
people with hypertension, with and without baseline diabetes mellitus or chronic kidney disease, are
controversial. In our previous NIH-funded research, using data from BioLINCC in people with heart failure (HF)
with preserved ejection fraction, we found a subset of 6 circulating proteins (CCL16, EPHB4, IGFBP-7, LTBR,
PLC, and TFF3), higher baseline levels of which were associated with adverse kidney outcomes (increase in
urine albumin-to-creatinine ratio (UACR) and decline in eGFR), and also associated with a composite event of
CV death, heart failure hospitalization, and aborted cardiac arrest. Our overarching hypothesis is that these
proteins are also associated with decline in eGFR and increase in UACR in people with hypertension prior to the
development of left ventricular hypertrophy or heart failure. We further hypothesize that intensive BP control will
ameliorate the association of these biomarkers with adverse CV and kidney outcomes. We plan to obtain
specimens from the Systolic Blood Pressure Intervention Trial (SPRINT), a study population with hypertension
without diabetes mellitus, and the Action to Control Cardiovascular Risk in Diabetes (ACCORD), a study
population with hypertension and diabetes, available in BioLINCC and use the Olink proteomics platform to
measure these 6 proteins. Our other biomarkers of interest, serum creatinine and UACR, are available in the
database. We will use these data to (Aim 1) determine whether higher baseline levels of a subset of prespecified
blood biomarkers, CCL16, EPHB4, IGFBP-7, LTBR, PLC, and TFF3, are associated with a CV composite of
non-fatal MI, stroke, CV death, congestive HF, or unstable angina in people with hypertension but without LVH
or HF; and identify whether intensive BP lowering ameliorates the association; and (Aim 2) determine whether
higher baseline levels of blood biomarkers, CCL16, EPHB4, IGFBP-7, LTBR, PLC, and TFF3, are associated
with (a) eGFR decline and (b) increase in UACR from baseline to 3 years in people with hypertension but without
LVH or HF; and identify whether intensive BP lowering ameliorates this association. We will also explore whether
diabetes will modify the association of these biomarkers with the CV and kidney outcomes in people with
hypertension. These biomarkers will be useful in early understanding of which people with hypertension are at
increased risk of kidney function decline and adverse CV events. Moreover, identifying such biomarkers will pave
the way for future studies to better understand kidney disease pathogenesis in the setting of hypertension.
Up to $238K
health research