Major adverse cardiovascular events

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Major adverse cardiovascular events (MACE, or major adverse cardiac events) is a composite endpoint frequently used in cardiovascular research. [1] [2] Despite widespread use of the term in clinical trials, the definitions of MACE can differ, which makes comparison of similar studies difficult. [3]

Contents

Definition

The so-called "classical 3-point MACE" is defined as a composite of nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death. [4] [5] But another study defines MACE as "CVD events, admission for HF (Heart Failure), ischemic cardiovascular [CV] events, cardiac death, or MACE". [6] Yet another study defined MACE as "CV death, hospitalization for HF, or myocardial infarction (MI)". [7]

The heterogeneity of the sets defining MACE, hampering systematic reviews and meta-analyses, has been repeatedly criticized. [8] [9] [10]

Risk factors for MACE

Which conditions are risk factors for MACE depends on some characteristics of the investigated cohort. Established risk indicators in the general population include age, pre-existing cardiovascular disease, smoking, diabetes mellitus, elevated concentrations of triglycerides and non-HDL cholesterol concentration, reduced HDL concentration and hypertension, as, e. g., demonstrated by the Framingham Heart Study. More recently, additional risk indicators have been identified, e. g. type 2 allostatic load, [11] high-sensitivity C-reactive protein, d-dimer level, [12] renal failure [13] and altered thyroid function. [14] [15] [16] [17]

Therapeutic interventions

Two reviews have concluded that SGLT2 inhibitors benefit patients with atherosclerotic MACE. [18] [19] One of those studies defined MACE as the composite of myocardial infarction, stroke, or cardiovascular death. [18] Other studies have shown MACE to be potently predicted by levels of ceramide found in patients. [20]


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References

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  3. ↑ Kip KE, Hollabaugh K, Marroquin OC, Williams DO (2008). "The problem with composite end points in cardiovascular studies: the story of major adverse cardiac events and percutaneous coronary intervention". Journal of the American College of Cardiology . 51 (7): 701–707. doi: 10.1016/j.jacc.2007.10.034 . PMID   18279733.
  4. ↑ de Jong M, van der Worp HB, van der Graaf Y, Visseren FL, Westerink J (2017). "Pioglitazone and the secondary prevention of cardiovascular disease. A meta-analysis of randomized-controlled trials". Cardiovascular Diabetology . 16 (1): 134. doi: 10.1186/s12933-017-0617-4 . PMC   5644073 . PMID   29037211.
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  6. ↑ Heianza Y, Ma W, Manson JE, Rexrode KM, Qi L (2017). "Gut Microbiota Metabolites and Risk of Major Adverse Cardiovascular Disease Events and Death: A Systematic Review and Meta-Analysis of Prospective Studies". Journal of the American Heart Association . 6 (7): e004947. doi:10.1161/JAHA.116.004947. PMC   5586261 . PMID   28663251.
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  16. ↑ Müller, P; Dietrich, JW; Lin, T; Bejinariu, A; Binnebößel, S; Bergen, F; Schmidt, J; Müller, SK; Chatzitomaris, A; Kurt, M; Gerguri, S; Clasen, L; Klein, HH; Kelm, M; Makimoto, H (15 April 2020). "Usefulness of Serum Free Thyroxine Concentration to Predict Ventricular Arrhythmia Risk in Euthyroid Patients With Structural Heart Disease". The American Journal of Cardiology. 125 (8): 1162–1169. doi:10.1016/j.amjcard.2020.01.019. PMID   32087999. S2CID   211261823.
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  19. ↑ Xu D, Chandler O, Xiao H (2021). "Sodium-Glucose Cotransporter-2 Inhibitor (SGLT2i) as a Primary Preventative Agent in the Healthy Individual: A Need of a Future Randomised Clinical Trial?". Frontiers in Medicine . 8: 712671. doi: 10.3389/fmed.2021.712671 . PMC   8419219 . PMID   34497814.
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