Associations between plasma ceramides and mortality in patients with coronary artery disease

Background and aims The relationship between ceramides and the risk of mortality among patients with coronary artery disease (CAD) is currently relatively sparse. This prospective study aimed to clarify whether plasma ceramides are associated with greater risks of cardiovascular and all-cause mortality among CAD patients. Methods Ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC–MS/MS) was used to measure plasma ceramides, C16:0, C18:0, C24:0, and C24:1, in 1704 CAD patients. Cox regression models were used to estimate the association between ceramides and the risk of cardiovascular and all-cause mortality. Results During the median 9.3-year follow-up, 396 all-cause deaths occurred, of which 253 were cardiovascular deaths. Plasma C16:0, C18:0 and C24:1 ceramides and their ratios with C24:0 ceramide were significantly associated with increased risk of cardiovascular and all-cause mortality. After multivariable adjusted, for 1-SD increases of C16:0/C24:0, C18:0/C24:0, and C24:1/C24:0 ratios, the risk of cardiovascular mortality increased by 27%, 35%, and 21%, and the risk of all-cause mortality increased by 29%, 28%, and 24%, respectively. Patients with higher ceramide risk score had 1.81-fold (95%CI, 1.24–2.64) and 1.95-fold (95%CI, 1.43–2.65) risk of cardiovascular and all-cause mortality, respectively, compared to patients with lower ceramide risk score. The risks of cardiovascular and all-cause mortality increased by 9% for 1-point increment in the ceramide risk score. Subgroup analyses did not substantially modify the results. Conclusions Our study documented that distinct ceramides were significantly associated with the risks of cardiovascular and all-cause mortality in CAD patients. Further studies are warranted to determine the clinical diagnostic value of distinct ceramides in identifying patients at risk of mortality.