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Adding cardiovascular biomarkers to established risk factors increases risk prediction
The addition of cardiovascular biomarkers to established risk factors leads to a small improvement in risk prediction of cardiovascular disease, according to a study published online May 13 in the Journal of the American Medical Association.
Johannes Tobias Neumann, M.D., Ph.D., from University Medical Center Hamburg-Eppendorf in Germany, and colleagues examined the prognostic value of routinely available cardiovascular biomarkers when added to established risk factors using data from 28 general population-based cohorts from 12 countries. The analyses included 164,054 individuals, with a median follow-up of 11.8 years.
The researchers identified 17,211 incident atherosclerotic cardiovascular disease events. Significant associations were seen for all biomarkers with incident atherosclerotic disease (subdistribution hazard ratio per 1-standard deviation change, 1.13, 1.18, 1.21, 1.14, and 1.14 for high-sensitivity cardiac troponin I, high-sensitivity cardiac troponin T, N-terminal pro-B-type natriuretic peptide, B-type natriuretic peptide, and high-sensitivity C-reactive protein, respectively) and for all secondary outcomes.
The C-statistic was improved with the addition of each single biomarker to a model that included established risk factors. In people younger than 65 years, the C-statistic for 10-year incident atherosclerotic cardiovascular disease improved from 0.812 to 0.8194 with the combination of high-sensitivity cardiac troponin I, N-terminal pro-B-type natriuretic peptide, and high-sensitivity C-reactive protein.
The most pronounced improvements in risk prediction were seen for the secondary outcomes of heart failure and all-cause mortality.
"The addition of biomarkers to established risk factors led to only a small improvement in risk prediction metrics for atherosclerotic cardiovascular disease, but was more favorable for heart failure and mortality," the authors write.
More information: Johannes Tobias Neumann et al, Prognostic Value of Cardiovascular Biomarkers in the Population, JAMA (2024). DOI: 10.1001/jama.2024.5596
Thomas A. Gaziano et al, Can Cardiovascular Risk Assessment Be Improved in the 21st Century?, JAMA (2024). DOI: 10.1001/jama.2024.7644
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