Galectin-3 is associated with risk of cardiovascular and kidney outcomes in ambulatory Veterans

Abstract: Rationale & Objective: Cardiovascular and kidney disease are highly prevalent comorbid conditions, and each is a risk factor for the other condition. We evaluated whether Galectin-3 (Gal-3), a biomarker of organ fibrosis, is associated with cardiovascular and kidney events in ambulatory Veterans. Study Design: An observational cohort study. Setting & Participants: Ambulatory Veterans presenting for an outpatient echocardiogram at the San Diego Veterans Affairs between 2010 and 2013. Predictor: Blood Gal-3 levels. Outcomes: The primary cardiovascular outcome was major adverse cardiac events (MACEs: acute coronary syndrome [ACS], stroke, heart failure [HF] hospitalization, or cardiovascular death). The primary kidney outcome was major adverse kidney events (MAKEs: ≥40% estimated glomerular filtration rate decrease or renal replacement therapy). Secondary outcomes were cardiovascular death, incident HF, ACS, and all-cause mortality. Analytical Approach: Cox proportional hazard models adjusting for cardiovascular and kidney disease risk factors. Results: A total of 882 Veterans with an average age of 66 ± 12 years, 97% were men, average eGFR of 78 ± 20 mL/min/1.73 m2, 40% prevalence of coronary artery disease, and 17% prevalence of HF. Higher Gal-3 was associated with a greater risk of MACEs (hazard ratio [HR], 1.54 per 2-fold higher Gal-3; 95% confidence interval [CI], 1.02-2.32; P = 0.04), cardiovascular death (HR, 3.41; 95% CI, 1.75-6.66; P < 0.001), and all-cause mortality (HR, 1.81; 95% CI, 1.41-2.33; P < 0.001), but not incident HF or ACS. Higher Gal-3 was associated with a greater risk of MAKEs (HR, 1.92; 95% CI, 1.20-3.08; P = 0.004). Higher Gal-3 was associated with >350% greater risk of experiencing both MACEs and MAKEs during follow-up (HR, 3.57; 95% CI, 1.63-7.84; P = 0.002). Limitations: Select population of Veterans presenting for an echocardiogram who were primarily older men with multiple comorbid conditions. Conclusions: Gal-3 is associated with risk of cardiovascular and kidney outcomes among ambulatory Veterans.