Cardiovascular Morbidity in Monoclonal Gammopathy of Undetermined Significance: A Danish Nationwide Study

Brian Schwartz*, Morten Schou, Frederick L. Ruberg, Dane Rucker, Jihoon Choi, Omar Siddiqi, Kevin Monahan, Lars Køber, Gunnar Gislason, Christian Torp-Pedersen, Charlotte Andersson

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

7 Citationer (Scopus)
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Abstract

Background: Monoclonal gammopathy of undetermined significance (MGUS) is associated with renal dysfunction, inflammation, and increased cardiovascular mortality, but the cardiovascular risks are not fully understood. Objectives: The authors explored the association of MGUS with a spectrum of cardiovascular diseases using the Danish nationwide databases. Methods: Between 1995 and 2018, patients 18 years and older with MGUS were age- and sex-matched (1:10) with control patients and followed prospectively until December 31, 2018, for the occurrence of cardiovascular diseases. Patients diagnosed with multiple myeloma, lymphoma, or amyloidosis were excluded. Multivariable adjusted hazard ratios (HRs) for cardiovascular outcomes were estimated using Cox proportional hazard regression. Results: Patients with MGUS (n = 8,189; mean age 69.8 ± 11.7 years; 51.2% male) had higher prevalence of cardiovascular risk factors at baseline, including hypertension (48.0% vs 38.5%) and type 2 diabetes (13.0% vs 9.3%), compared with control patients. Outcomes included an increased risk of heart failure (HR: 1.55; 95% CI: 1.41-1.69), acute myocardial infarction (HR: 1.22; 95% CI: 1.06-1.40), ischemic stroke (HR: 1.16; 95% CI: 1.03-1.30), atrial fibrillation (HR: 1.32; 95% CI: 1.23-1.42), aortic aneurysm (HR: 1.55; 95% CI: 1.28-1.89), aortic stenosis (HR: 1.60; 95% CI: 1.41-1.82), aortic regurgitation (HR: 1.67; 95% CI: 1.34-2.07), heart block (HR: 1.32; 95% CI: 1.08-1.61), peripheral artery disease (HR: 1.69; 95% CI: 1.47-1.95), cor pulmonale (HR: 2.06; 95% CI: 1.55-2.73), and venous thromboembolism (HR: 1.43; 95% CI: 1.24-1.65). A sensitivity analysis including only patients without certain comorbidities (type 2 diabetes, hypertension, acute myocardial infarction, and chronic kidney disease) yielded similar results. Conclusions: MGUS is associated with a broad spectrum of cardiovascular diseases, with greater relative risks observed for diseases previously associated with infiltrative and inflammatory disorders. Further studies are warranted to explore the underlying mechanisms.

OriginalsprogEngelsk
TidsskriftJACC: CardioOncology
Vol/bind4
Udgave nummer3
Sider (fra-til)313-322
Antal sider10
ISSN2666-0873
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
This work was supported by National Institutes of Health grant 1R38HL143584, Multi-Disciplinary Training for Promoting Research In Medical Residency (Dr Schwartz). Dr Schou has received fees from Boehringer Ingelheim, AstraZeneca, and Novo Nordisk for lectures that are unrelated to the present work. Dr Ruberg has received research funding from NIH/NHLBI (R01-HL139671), Alnylam Pharmaceuticals, Akcea Therapeutics, and Pfizer; and consulting income from Attralus and Alexion Pharmaceuticals unrelated to the present work. Dr Køber has received fees from Novartis, BMS, and AstraZeneca for lectures that are unrelated to the present work. Dr Torp-Pedersen has received study funding from Bayer and Novo Nordisk that is unrelated to the present work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2022 The Authors

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