Author + information
- Received February 9, 2018
- Revision received February 26, 2018
- Accepted February 27, 2018
- Published online March 10, 2018.
- Anum Saeed, MD1,
- Vijay Nambi, MD, PhD1,2,
- Wensheng Sun, MPH, MS1,
- Salim S. Virani, MD, PhD1,2,
- George Taffet, MD1,
- Anita Deswal, MD1,
- Elizabeth Selvin, PhD, MPH3,
- Kunihiro Matsushita, MD3,
- Lynne E. Wagenknecht, DrPH4,
- Ron Hoogeveen, PhD1,
- Josef Coresh, PhD, MPH3,
- James A. de Lemos, MD5 and
- Christie M. Ballantyne, MD1,∗ ()
- 1Baylor College of Medicine, Houston, Texas
- 2Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- 3Johns Hopkins University, Baltimore, MD
- 4Wake Forest University, Winston-Salem, North Carolina
- 5University of Texas–Southwestern Medical Center, Dallas, Texas
- ↵∗Corresponding author: Christie M. Ballantyne, MD Baylor College of Medicine One Baylor Plaza, MS BCM285 Houston, TX 77030 Telephone: 713-798-5034 Fax: 713-798-3057.
Background Current prevention guidelines recommend using the Pooled Cohort Equation (PCE) for 10-year atherosclerotic cardiovascular disease (CVD) risk assessment. However, the PCE has serious limitations in older adults: it excludes heart failure (HF) hospitalization, estimates 10-year risk which may not be the most relevant time frame, and is not indicated for individuals aged >79 years.
Objectives To determine whether adding biomarkers to PCE variables improves global CVD (coronary heart disease [CHD], stroke, and HF) risk prediction in older adults over a shorter time period.
Methods Atherosclerosis Risk in Communities Study participants without prevalent CVD including HF (n=4760; mean±SD age=75.4±5.1 years) were followed for incident global CVD events. Adding N-terminal pro–B-type natriuretic peptide, high-sensitivity cardiac troponin T, and high-sensitivity C-reactive protein to the PCE and a “lab model” with the biomarkers, age, race, and gender were assessed for prediction improvement. Area under the receiver operating characteristic curve (AUC) and net reclassification index (NRI) were calculated.
Results Over median follow-up of ∼4 years, incident HF was the leading CVD event (n=193 vs 118 CHD and 81 stroke events). Compared to the PCE, each biomarker improved risk prediction. The largest improvement in risk prediction metrics was with the addition of all 3 biomarkers (ΔAUC 0.103; continuous NRI 0.484). The lab model also performed better than the PCE model (ΔAUC 0.091, continuous NRI 0.355).
Conclusions Adding biomarkers to the PCE or a simpler “lab model” improves short-term global CVD risk prediction and may be useful to inform short-term preventive strategies in older adults.
Funding: The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under contract nos. HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). E.S. was supported by R01-DK089174. C.M.B. was supported by R01-HL134320.
Disclosures: A. Saeed: None. V. Nambi: Research Grant; Significant; Roche Patent. Expert Witness; Modest; Siemens (compensation for event adjudication). W. Sun: None. S.S. Virani: Research Grant; Significant; AHA, ADA, VA. Honoraria; Significant; American College of Cardiology, National Lipid Association. Other; Significant; Steering comittee: PALM Registry at Duke University (no financial remuneration). G.E. Taffet: None. A. Deswal: None. E. Selvin: Research Grant; Significant; NIH, FNIH. K. Matsushita: None. L.E. Wagenknecht: None. R. Hoogeveen: Research Grant; Modest; Denka Seiken. J. Coresh: None. J. De Lemos: Consultant/Advisory Board; Modest; Roche Diagnostics, Abbott Diagnostics, Ortho Clinical Diagnostics, Amgen, Novo Nordisc, Regeneron. C.M. Ballantyne: Other Research Support; Significant; Abbott Diagnostic, Amarin, Amgen, Eli Lilly, Esperion, Novartis, Pfizer, Regneron, Roche, Sanofi, Takeda. Provisional patent (patent no. 61721475) entitled “Biomarkers to Improve Prediction of Heart Failure Risk” filed by Baylor College of Medicine and Roche (V. Nambi, R. Hoogeveen, CM Ballantyne).
- Received February 9, 2018.
- Revision received February 26, 2018.
- Accepted February 27, 2018.
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