A large, individual-level data analysis, of 28 general population–based cohorts from 12 countries has revealed that cardiovascular biomarkers were strongly associated with fatal and nonfatal cardiovascular events and mortality.
The report was published in JAMA and the lead author is Johannes Tobias Neumann, MD, PhD.
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 study looked at high-sensitivity cardiac troponins I and T, B-type natriuretic peptide, and high-sensitivity C-reactive protein were associated with fatal and nonfatal events.
“One major advantage of this analysis is the collection of individual-level data from many cohorts from around the globe spanning 4 continents. Another advantage of this study is the excellent use of existing cohorts with long follow-up averaging about 12 years and as long as 28 years,” wrote Thomas A. Gaziano, MD, MSc, of Brigham and Women’s Hospital in an accompanying editorial.
Cardiovascular biomarkers, such as cardiac troponin, natriuretic peptides, and C-reactive protein (CRP), are established in clinical care. Using newer, high-sensitivity cardiac troponin assays, concentrations became measurable in the general population, opening up the prospects for a broader application of this biomarker.5 Several studies have reported strong associations of these biomarkers with incident atherosclerotic cardiovascular disease events in individuals with known atherosclerotic cardiovascular disease,
Cardiovascular risk assessment is an essential part of preventive care to target risk factor interventions and has contributed to dramatic reductions in cardiovascular disease mortality during the past 60 years in the US and other countries.
In this study, for each analysis, there were tens of thousands of individuals to more than 100 000 individuals included in the specific biomarker analyses. Each of the biomarkers was associated with the cardiovascular outcomes studied and, when added to the basic prediction tool, they demonstrated significant, but modest, incremental improvements in the discriminatory power with the changes generally in the second or third decimal place of the C statistic.
Cardiovascular biomarkers were strongly associated with fatal and nonfatal cardiovascular events and 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.
Early identification of individuals at high risk for atherosclerotic cardiovascular disease shapes primary preventive strategies to reduce the risk of developing atherosclerotic cardiovascular disease.
“With so many options for improvement in risk assessment, how do clinicians or guideline committees decide which ones to use or recommend? The currently available risk prediction equations are handy because the data elements are usually readily available in the clinical setting and can easily be calculated from available elements in the electronic medical record,” said Graziano.
