Elevated VCAM-1 Levels Associated With Long-Term Risk of Heart Failure

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VCAM-1 has been implicated in the pathogenesis of heart failure with preserved ejection fraction (HFpEF), but what is the association of VCAM-1 with development of clinically overt heart failure (HF) across ejection fraction categories?

Increased serum levels of vascular cell adhesion molecule-1 (VCAM-1) are significantly associated with incident heart failure after a long-term follow-up, according to a study in the Journal of the American Heart Association.

Researchers evaluated the association of VCAM-1 with incident heart failure (heart failure with preserved ejection fraction [HFpEF] and heart failure with reduced ejection fraction [HFrEF]) after adjusting for cardiovascular risk factors in the Multi-Ethnic Study of Atherosclerosis. Incident heart failure was considered to be the first hospitalization for symptomatic heart failure.

From 2000 to 2002, 6814 participants (aged 45 to 84 years) were recruited from 6 study sites in the United States. A total of 2297 participants (mean age, 61.4 ± 10.1 years; 52.1% women; 24.1% Black; 24.7% White; 25.4% Hispanic; and 25.9% Chinese) were included in the analysis. Those with a higher VCAM-1 level were more likely to be white, have higher blood pressure, and have lower kidney function.

During a median follow-up of 14.4 years, 102 heart failure events occurred (HFpEF = 65; HFrEF = 37). After covariate adjustment, each doubling of VCAM-1 level was associated with incident heart failure (hazard ratio [HR], 1.94; 95% CI, 1.17-3.23; P = .01). Current or former smokers appeared to have a stronger association compared with never smokers.

After evaluating for heart failure subtypes, the researchers found that VCAM-1 level was associated with incident HFpEF (HR, 1.97; 95% CI, 1.04-3.72; P = .04) but not with incident HFrEF; however, the risk estimates were consistent (HR, 1.82; 95% CI, 0.79-4.21; P = .16).

“Baseline serum VCAM-1 was significantly associated with incident heart failure hospitalization,” stated the investigators. “The risk of heart failure increased progressively with higher levels of VCAM-1, with plateauing of risk at the highest levels of this biomarker.”

The study authors noted that several participants were excluded because of a lack of VCAM-1 measurement, and those who were excluded represented a higher-risk group with more cardiovascular risk factors. Further investigation is also needed to understand whether serum VCAM-1 levels are reflective of VCAM-1 activity and expression at the level of the coronary microvasculature.

“Taken together, our findings substantiate the potential pathogenic roles of endothelial activation, cellular adhesion molecules, and microvascular coronary inflammation in driving symptomatic HFpEF and heart failure hospitalization,” the researchers commented. “Therapies aimed to reduce endothelial activation and specifically VCAM-1 may prevent incident heart failure among patients at risk.”

Disclosures: One of the study authors reported affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Patel RB, Colangelo LA, Bielinski SJ, et al. circulating vascular cell adhesion molecule-1 and incident heart failure: the multi-ethnic study of atherosclerosis (MESA). J Am Heart Assoc. 2020;9(22):e019390.