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96 years (median 4.0 years) on atorvastatin and 3.91 years (median 4.08 years) on placebo. A total of 1098 patients had a PAPP-A measurement at baseline. Of those, 534 patients died during follow-up, of whom 141 LY2109761 cell line patients died of SCD and 114 due to infection. A total of 398 patients reached the CVE with MI and stroke occurring in 169 and 85 patients, respectively. Mean age of the patients was 66?��?8 years and median serum concentration of PAPP-A was 17.0 (IQR 13.4�C20.9)?mIU/L with minimum concentration of 6.4?mIU/L and maximum concentration of 124.7?mIU/L. Patients characteristics according to PAPP-A quartiles at baseline are shown in Table?1. Baseline PAPP-A levels were significantly associated with all-cause mortality and specific adverse clinical outcomes. We found no sex-specific differences when data were analyzed separately for men and for women. Detailed analysis of cardiovascular events revealed a significant association of high PAPP-A levels with sudden cardiac death but not with myocardial infarction. The respective HRs and corresponding 95% CI are shown in Table?2 (evaluation of PAPP-A as a continuous variable) and Table?3 (evaluation of PAPP-A according to quartiles). Kaplan�CMeier survival curves for overall mortality, combined cardiovascular events, mortality due to infection and sudden cardiac death are shown in Fig.?1. Analysis of specific cardiovascular events revealed a significantly increased risk of sudden death in www.selleckchem.com/products/epz-5676.html patients with high PAPP-A levels (adjusted HR 1.23, 95% CI 1.12�C1.36, p?=?0.001 for PAPP-A as continuous variable (per standard deviation), adjusted HR 2.62, 95%CI 1.54�C4.46, p?MAPK risk of stroke in the quartile analyses (adjusted HR 2.80, 95% CI 1.30�C6.00, p?=?0.008 for the 4th vs. 1st quartile). In contrast, no association of PAPP-A with myocardial infarction was found. Investigating cardiovascular events combined, patients in the 4th quartile had the unequivocally worst prognosis (HR 1.46, 95% CI 1.06�C2.01, p?=?0.022 vs. first quartile, adjusted analysis). Per standard deviation increase in PAPP-A level, patients had a 16% increased risk of infectious death after adjustment for potential confounders (HR 1.16, 95% CI 1.00�C1.36, p?=?0.055). When PAPP-A was tested according to quartiles, patients in the 3rd and 4th quartiles had evidently worse prognosis compared with the 1st quartile (3rd quartile: HR 2.28, 95% CI 1.23�C4.23, p?=?0.009 vs. 1st quartile; 4th quartile: 2.92, 95% CI 1.54�C5.54, p?