Novel and conventional biomarkers for prediction of incident cardiovascular events in the community
Melander O et al. – Selected biomarkers may be used to predict future cardiovascular events, but the gains over conventional risk factors are minimal. Risk classification improved in intermediate-risk individuals, mainly through the identification of those unlikely to develop events. Methods- Study of the utility of contemporary biomarkers for predicting cardiovascular risk when added to conventional risk factors
- Cohort study of 5067 pts (mean age, 58 yrs; 60% women) without cardiovascular disease from Malmö, Sweden, who had baseline examination between 1991-1994
- Measurement of C-reactive protein (CRP), cystatin C, lipoprotein-associated phospholipase 2, midregional proadrenomedullin (MR-proADM), midregional proatrial natriuretic peptide, and N-terminal pro-B-type natriuretic peptide (N-BNP)
- Follow-up until 2006 using Swedish national hospital discharge and cause-of-death registers and the Stroke in Malmö register for first cardiovascular events (myocardial infarction, stroke, coronary death)
- Main outcome measures: incident cardiovascular and coronary events
Results- During median follow-up of 12.8 yrs, 418 cardiovascular and 230 coronary events
- Models with conventional risk factors had C statistics of 0.758 and 0.760 for cardiovascular and coronary events, respectively
- Biomarkers retained in backward-elimination models were CRP and N-BNP for cardiovascular events and MR-proADM and N-BNP for coronary events, which increased C statistic by 0.007 and 0.009, respectively
- Modest proportion of pts reclassified: 8% for cardiovascular risk, 5% for coronary risk
- Net reclassification improvement: nonsignificant for cardiovascular events and coronary events
- Greater improvements in analyses restricted to intermediate-risk pts
- Correct reclassification almost entirely confined to down-classification of pts without events vs up-classification of pts with events
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