Cardiology Medical News about incident cardiovascular events;biomarkers for prediction

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Novel and conventional biomarkers for prediction of incident cardiovascular events in the community
JAMA, 07/02/09

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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