Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (May 2020)

Distinct Characteristics of VEGF‐D and VEGF‐C to Predict Mortality in Patients With Suspected or Known Coronary Artery Disease

  • Hiromichi Wada,
  • Masahiro Suzuki,
  • Morihiro Matsuda,
  • Yoichi Ajiro,
  • Tsuyoshi Shinozaki,
  • Satoru Sakagami,
  • Kazuya Yonezawa,
  • Masatoshi Shimizu,
  • Junichi Funada,
  • Takashi Takenaka,
  • Yukiko Morita,
  • Toshihiro Nakamura,
  • Kazuteru Fujimoto,
  • Hiromi Matsubara,
  • Toru Kato,
  • Takashi Unoki,
  • Daisuke Takagi,
  • Kyohma Wada,
  • Miyaka Wada,
  • Moritake Iguchi,
  • Nobutoyo Masunaga,
  • Mitsuru Ishii,
  • Hajime Yamakage,
  • Toru Kusakabe,
  • Akihiro Yasoda,
  • Akira Shimatsu,
  • Kazuhiko Kotani,
  • Noriko Satoh‐Asahara,
  • Mitsuru Abe,
  • Masaharu Akao,
  • Koji Hasegawa

DOI
https://doi.org/10.1161/JAHA.119.015761
Journal volume & issue
Vol. 9, no. 9

Abstract

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Background VEGF‐D (vascular endothelial growth factor D) and VEGF‐C are secreted glycoproteins that can induce lymphangiogenesis and angiogenesis. They exhibit structural homology but have differential receptor binding and regulatory mechanisms. We recently demonstrated that the serum VEGF‐C level is inversely and independently associated with all‐cause mortality in patients with suspected or known coronary artery disease. We investigated whether VEGF‐D had distinct relationships with mortality and cardiovascular events in those patients. Methods and Results We performed a multicenter, prospective cohort study of 2418 patients with suspected or known coronary artery disease undergoing elective coronary angiography. The serum level of VEGF‐D was measured. The primary outcome was all‐cause death. The secondary outcomes were cardiovascular death and major adverse cardiovascular events defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. During the 3‐year follow‐up, 254 patients died from any cause, 88 died from cardiovascular disease, and 165 developed major adverse cardiovascular events. After adjustment for possible clinical confounders, cardiovascular biomarkers (N‐terminal pro‐B‐type natriuretic peptide, cardiac troponin‐I, and high‐sensitivity C‐reactive protein), and VEGF‐C, the VEGF‐D level was significantly associated with all‐cause death and cardiovascular death but not with major adverse cardiovascular events.. Moreover, the addition of VEGF‐D, either alone or in combination with VEGF‐C, to the model with possible clinical confounders and cardiovascular biomarkers significantly improved the prediction of all‐cause death but not that of cardiovascular death or major adverse cardiovascular events. Consistent results were observed within patients over 75 years old. Conclusions In patients with suspected or known coronary artery disease undergoing elective coronary angiography, an elevated VEGF‐D value seems to independently predict all‐cause mortality.

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