Results:

The investigators found that at baseline, sST2 levels averaged 28.7 ± 16.2 ng/ml; significantly (p < 0.001) higher in men than women, but supranormal in only 9% and 15%, respectively. They modeled the continuous relationship between sST2 and the log hazard ratio for outcomes as two linear segments, with a significant decrease in the rate of increase in hazard ratios >33.2 ng/ml. They reported that each segment of the sST2 distribution was significantly (p < 0.0001) associated with the risks of morbid event, mortality, and hospitalization for HF. However, only sST2 values <33.2 ng/ml were significantly related to the outcomes when 23 readily available clinical variables including N-terminal pro–B-type natriuretic peptide (NT-proBNP) were included in the Cox regression model. They found that sST2 did not improve discrimination of patient outcomes. When compared to placebo, valsartan significantly (p < 0.001) reduced the rate of increase in sST2. Increases in sST2 over a 12-month period, but not decreases, were significantly associated with subsequent outcomes independent of clinical variables, sST2, and valsartan treatment.