Soluble endothelial cell selective adhesion molecule and cardiovascular outcomes in patients with stable coronary disease: A report from the Heart and Soul Study

• Endothelial cell-selective adhesion molecule (ESAM) is postulated to play a role in atherogenesis.
• We found that in the Heart and Soul Study, soluble ESAM levels associate with myocardial infarction, heart failure, and death after adjustment for demographic and clinical risk factors.
• These associations are completely attenuated after adjustment for kidney function.
• sESAM may be a marker for cardiovascular risk among individuals with chronic kidney disease.

Background and AimsEndothelial cell-selective adhesion molecule (ESAM) is selectively expressed on vascular endothelium and is postulated to play a role in atherogenesis. We investigated the association of serum soluble ESAM (sESAM) levels with subsequent cardiovascular outcomes in patients with stable ischemic heart disease.MethodsWe measured sESAM levels in 981 patients with stable coronary disease enrolled between September 2000 and December 2002 in a prospective cohort study. Poisson regression models were used to define the relationship between baseline sESAM levels and cardiovascular outcomes, including myocardial infarction, heart failure hospitalization, and mortality.ResultsThere were 293 occurrences of the composite endpoint over a median follow-up of 8.9 years. After adjusting for demographic and clinical risk factors, participants in the highest sESAM quartile (compared to the lower three sESAM quartiles) had a higher rate of the composite endpoint (incident rate ratio (IRR) 1.52 (95% CI 1.16–1.99) as well as of its individual components: myocardial infarction (IRR 1.64 (1.06–2.55)), heart failure hospitalizations (IRR 1.96 (1.32–2.81)), and death (IRR 1.5 (1.2–1.89)). These associations were no longer significant after adjustment for estimated glomerular filtration rate.ConclusionssESAM levels associate with myocardial infarction, heart failure, and death after adjustment for demographic and clinical risk factors, but not after adjustment for kidney function. sESAM may be involved in the pathogenesis of concurrent kidney and cardiovascular disease.