BACKGROUND: Growth differentiation factor 15 (GDF-15) is expressed and secreted 
in response to inflammation, oxidative stress, hypoxia, telomere erosion, and 
oncogene activation. Cardiovascular (CV) disease is a major driver of GDF-15 
production. GDF-15 has favorable preanalytic characteristics and can be measured 
in serum and plasma by immunoassay.
CONTENT: In community-dwelling individuals higher concentrations of GDF-15 are 
associated with increased risks of developing CV disease, chronic kidney 
disease, and cancer, independent of traditional CV risk factors, renal function, 
and other biomarkers (C-reactive protein, B-type natriuretic peptide, cardiac 
troponin). Low concentrations of GDF-15 are closely associated with longevity. 
GDF-15 is as an independent marker of all-cause mortality and CV events in 
patients with coronary artery disease, and may help select patients with 
non-ST-elevation acute coronary syndrome for early revascularization and more 
intensive medical therapies. GDF-15 is independently associated with mortality 
and nonfatal events in atrial fibrillation and heart failure (HF) with preserved 
or reduced ejection fraction. GDF-15 reflects chronic disease burden and acute 
perturbations in HF and responds to improvements in hemodynamic status. GDF-15 
is independently associated with major bleeding in patients receiving 
antithrombotic therapies and has been included in a new bleeding risk score, 
which may become useful for decision support.
SUMMARY: GDF-15 captures distinct aspects of CV disease development, 
progression, and prognosis, which are not represented by clinical risk 
predictors and other biomarkers. The usefulness of GDF-15 to guide management 
decisions and discover new treatment targets should be further explored.