Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Coronary Event Risk Test (CERT) as Risk Predictor for the 10-Year Clinical Outcome of Patients with Peripheral Artery Disease

Andreas Leiherer
* ORCID logo ,
Axel Muendlein
ORCID logo ,
Christoph H Saely
,
Kathrin Geiger
,
Eva-Maria Brandtner
,
Christine Heinzle
,
Stella Gaenger
,
Reijo Laaksonen
,
Peter Fraunberger
,
Heinz Drexel
ORCID logo
Version 1 : Received: 27 July 2023 / Approved: 28 July 2023 / Online: 28 July 2023 (11:43:11 CEST)

A peer-reviewed article of this Preprint also exists.

Leiherer, A.; Muendlein, A.; Saely, C.H.; Geiger, K.; Brandtner, E.-M.; Heinzle, C.; Gaenger, S.; Mink, S.; Laaksonen, R.; Fraunberger, P.; Drexel, H. Coronary Event Risk Test (CERT) as a Risk Predictor for the 10-Year Clinical Outcome of Patients with Peripheral Artery Disease. J. Clin. Med. 2023, 12, 6151. Leiherer, A.; Muendlein, A.; Saely, C.H.; Geiger, K.; Brandtner, E.-M.; Heinzle, C.; Gaenger, S.; Mink, S.; Laaksonen, R.; Fraunberger, P.; Drexel, H. Coronary Event Risk Test (CERT) as a Risk Predictor for the 10-Year Clinical Outcome of Patients with Peripheral Artery Disease. J. Clin. Med. 2023, 12, 6151.

Abstract

Background: Ceramides are a new kind of lipid biomarkers and have already been demonstrated to be valuable risk predictors in coronary patients. Patients with peripheral artery disease (PAD) are a population with worse prognosis and higher mortality risk compared to coronary artery disease (CAD) patients. However, the value of ceramides for risk prediction in PAD patients is still vague and has been addressed in the present study. Methods: This observational study included 379 PAD patients. The primary endpoint was all-cause mortality at 10 years of follow-up. A set of ceramides was measured by LC-MS/MS and combined according to the coronary event risk test (CERT) score which categorizes patients into one of four risk groups (low risk, moderate risk, high risk, very high risk). Results: Kaplan Meier survival curves revealed that the overall survival of patients has decreased with the increasing risk predicted by the four CERT categories, advancing from low risk to very high risk. Cox regression analysis demonstrated that every 1-step increase in category resulted in a 35% rise in overall mortality risk (HR=1.35 [1.16-1.58]). Multivariable adjustment, including amongst others age, T2DM, and statin treatment before baseline, did not abrogate this significant association (HR=1.22 [1.04-1.43]). Moreover, we found that the beneficial effect of statin is significantly stronger in patients with a higher risk according to CERT. Conclusion: We conclude that the ceramide-based risk score CERT is a strong predictor of the 10-year mortality risk in patients with PAD.

Keywords

peripheral artery disease; biomarker; ceramides; CERT; mortality; MACE; risk factors; statin

Subject

Medicine and Pharmacology, Internal Medicine

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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