Objective
Ceruloplasmin (Cp) is an acute-phase reactant that is increased in inflammatory diseases and in acute coronary syndromes. Cp has recently been shown to possess nitric oxide (NO) oxidase catalytic activity, but its impact on long-term cardiovascular outcomes in stable cardiac patients has not been explored.
Methods and Results
We examined serum Cp levels and their relationship with incident major adverse cardiovascular events (MACE = death, myocardial infarction [MI], stroke) over 3-year follow-up in 4,177 patients undergoing elective coronary angiography. We also carried out a genome-wide association study (GWAS) to identify the genetic determinants of serum Cp levels and evaluate their relationship to prevalent and incident cardiovascular risk. In our cohort (age 63±11 years, 66% male, 32% history of MI, 31% diabetes mellitus), mean Cp level was 24±6 mg/dL. Serum Cp level was associated with greater risk of MI at 3 years (Hazard ratio [HR, Quartile 4 versus 1] 2.35, 95% confidence interval [CI] 1.79–3.09, p<0.001). After adjusting for traditional risk factors, high-sensitivity C-reactive protein, and creatinine clearance, Cp remained independently predictive of MACE (HR 1.55, 95% CI 1.10–2.17, p=0.012). A two-stage GWAS identified a locus on chromosome 3 over the CP gene that was significantly associated with Cp levels (lead SNP rs13072552; p=1.90 × 10−11). However, this variant, which leads to modestly increased serum Cp levels (~1.5–2 mg/dL per minor allele copy), was not associated with coronary artery disease or future risk of MACE.
Conclusion
In stable cardiac patients, serum Cp provides independent risk prediction of long-term adverse cardiac events. Genetic variants at the CP locus that modestly affect serum Cp levels are not associated with prevalent or incident risk of coronary artery disease in this study population.