Galectin-3 and incident heart failure among patients with pre-existing coronary artery disease: The ADVANCE study

Background: Galectin-3 (Gal-3) is a novel fibrosis biomarker. We ascertained: 1) the correlates of Gal-3, and 2) its association with incident heart failure among 1312 participants in The ADVANCE study (871 subjects with acute myocardial infarction [AMI] and 441 subjects with stable angina). Methods: Cohort design, with Gal-3 measured in stored baseline serum samples (2002–04). After a median (SD) follow-up of 8.1 (3.2) years, 74 incident heart failure events were documented. Results: The significant independent correlates of Gal-3 were age, gender, diabetes, C-reactive protein and estimated glomerular filtration rate. In Cox regression with adjustment for these variables plus race, CAD presentation, smoking status, body mass index, hypertension and cholesterol lowering drugs, there was a 1.51-fold (95% CI, 1.24 to 1.85; p < 0.0001) increased hazard of heart failure for each SD linear increment in Gal-3. In the fully-adjusted model, quartile four of Gal-3 (relative to quartile one) was associated with 2.1-fold increased hazard of heart failure (95% CI, 1.05 to 4.2). The C-statistic increased to 0.78 from 0.75 (p = 0.12) and the net reclassification index was 0.13 (SE = 0.06; p = 0.03) after adding Gal-3 quartiles to the model containing all risk factors. Conclusions: Gal-3 is a useful marker of heart failure risk among patients with pre-existing coronary disease and may play an etiological role in the development of heart failure