The association between serum cathepsin L and mortality in older adults

• Published in: Atherosclerosis Vol. 254; pp. 109 - 116
• Main Authors: Feldreich, Tobias, Carlsson, Axel C., Risérus, Ulf, Larsson, Anders, Lind, Lars, Ärnlöv, Johan
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.11.2016
• Subjects: Adolescence; Age Factors; Aged; Atherosclerosis; Cardiovascular; Cardiovascular Diseases - blood; Cardiovascular Diseases - mortality; Cathepsin; Cathepsin L - blood; Cognitive interviewing; Epidemiology; Feel; Female; Health and Welfare; Health assessment; Humans; Hälsa och välfärd; Inflammation; Kidney Diseases - blood; Kidney Function Tests; Longitudinal Studies; Male; Mortality; Population based studies; Prevalence; Proportional Hazards Models; Qualitative; Self-rated health; Sex Factors; Subjective health; Sweden; Think-aloud interview; Cathepsin; Cardiovascular; Epidemiology; Mortality; Population based studies; Atherosclerosis
• ISSN: 0021-9150; 1879-1484; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2016.09.062

Research suggests that the protease cathepsin L is causally involved in atherosclerosis. However, data on cathepsin L as a risk marker are lacking. Therefore, we investigated associations between circulating cathepsin L and cardiovascular mortality. Two independent community-based cohorts were used: Uppsala Longitudinal Study of Adult Men (ULSAM); n = 776; mean age 77 years; baseline 1997–2001; 185 cardiovascular deaths during 9.7 years follow-up, and Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS); n = 993; 50% women; mean age 70 years; baseline 2001–2004; 42 cardiovascular deaths during 10.0 years follow-up. Higher serum cathepsin L was associated with an increased risk for cardiovascular mortality in age- and sex-adjusted models in both cohorts (ULSAM: hazard ratio (HR) for 1-standard deviation (SD) increase, 1.17 [95% CI, 1.01–1.34], p = 0.032 PIVUS: HR 1.35 [95% CI, 1.07–1.72], p = 0.013). When merging the cohorts, these associations were independent of inflammatory markers and cardiovascular risk factors, but non-significant adjusting for kidney function. Individuals with a combination of elevated cathepsin L and increased inflammation, kidney dysfunction, or prevalent cardiovascular disease had a markedly increased risk, while no increased risk was associated with elevated cathepsin L, in the absence of these disease states. An association between higher serum cathepsin L and increased risk of cardiovascular mortality was found in two independent cohorts. Impaired kidney function appears to be an important moderator or mediator of these associations. Further studies are needed to delineate the underlying mechanisms and to evaluate whether the measurement of cathepsin L might have clinical utility. •An associations between circulating cathepsin L and cardiovascular mortality was proposed.•Higher serum cathepsin L was associated with an increased risk for cardiovascular mortality in age- and sex-adjusted models.•Subjects with elevated cathepsin L and increased inflammation, kidney dysfunction, or prevalent CVD had an increase in risk.•Adjustment for kidney function attenuated the associations indicating impaired kidney function as an important mediator.