Cardiovascular
The Metabolic Vulnerability Index as predictor of Major Cardiovascular Adverse Events in the ELSA-Brasil Cohort William R. Tebar* William Tebar Vandrize Meneghini Marcio S. Bittencourt Raul D. Santos Giuliano Generoso Alexandre C. Pereira Steven R. Jones Michael J. Blaha Peter P. Toth Paulo A. Lotufo Isabela M. Bensenor
Introduction: The Metabolic Vulnerability Index (MVX), derived from the Metabolic Malnutrition (MMX) and Inflammation Vulnerability (IVX) indices, has been a novel biomarker associated with mortality prediction in patients with cardiovascular (CV) disease. However, it is still unclear if these indices predict risk for Major Adverse CV Events (MACE).
Objective: To analyze the association of MVX, MMX and IVX levels with MACE in the ELSA-Brasil cohort.
Methods: Data from 4893 participants (50.0 [45.0-57.0] years, 54.6% of women) were analyzed. Baseline serum samples were collected between the years 2008-2010. Components of MVX (leucine, isoleucine, valine, citrulline, GlycA and small HDL particles) were analyzed by nuclear magnetic resonance spectroscopy (LipoProfile® 4 test spectra, LabCorp) and the indices were stratified into quintiles and standard-deviation (SD) increase of z-scored values. Non-fatal MACE (myocardial infarction, stroke, admission for unstable angina, revascularization) were computed within a 5-year follow-up, while fatal MACE (cardiovascular death) were computed up to 31 December 2022. Kaplan-Meier curves of cumulative hazard for MACE were compared by log-rank test and the hazard ratio (HR) for MACE was analyzed by Cox regression adjusted for sociodemographic, risk factors and CV disease.
Results: A total of 189 MACE (40 fatal and 149 non-fatal) were adjudicated. Log-rank test was significant for all three indices (Figure 1). The HR of MACE was higher in participants with ≥2 SD of the three indices (HR: 2.57, 1.36 – 4.86 for MVX; HR: 2.06, 1.11 – 3.81 for MMX; and HR: 2.48, 1.32 – 4.66 for IVX). The highest quintile of all indexes was associated with higher HR of MACE when compared to the lowest quintile (HR: 2.06 [1.27; 3.37] for MVX; HR: 1.91 [1.12; 3.23] for MMX; HR: 1.82 [1.12; 2.95] for IVX).
Conclusion: The highest quintile and 2-fold increased z-score of MVX, MMX and IVX indices are predictors of MACE among ELSA-Brasil cohort participants.
