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New risk markers may change the HeartScore risk classification significantly in one-fifth of the population
M H Olsen1, T W Hansen, M K Christensen
1Research Center for Prevention and Health, Glostrup, Denmark. mho@dadlnet.dk
Insights
Urine albumin/creatinine ratio (UACR) and high-sensitivity C-reactive protein (hsCRP) improve cardiovascular risk prediction, especially in lower-risk individuals. These biomarkers help refine risk classification beyond traditional methods like HeartScore.
Area of Science:
- Cardiology
- Biomarkers
- Risk Prediction
Background:
- Cardiovascular disease remains a leading cause of mortality globally.
- Accurate risk stratification is crucial for effective primary prevention strategies.
- Current risk scores may not fully capture individual risk, particularly in lower-risk populations.
Purpose of the Study:
- To evaluate the added value of urine albumin/creatinine ratio (UACR), high-sensitivity C-reactive protein (hsCRP), and N-terminal pro-brain natriuretic peptide (Nt-proBNP) to existing cardiovascular risk prediction models.
- To assess the impact of these biomarkers on risk reclassification in different population subgroups.
Main Methods:
- A Danish population cohort of 2460 individuals was stratified into three groups: those with existing cardiovascular disease/diabetes, high-risk (HeartScore >5%), and low-moderate risk (HeartScore <5%).
- The study followed participants for 9.5 years, monitoring a composite endpoint of cardiovascular death, non-fatal myocardial infarction, or stroke (CEP).
- Statistical analyses, including hazard ratios and interaction tests, were used to determine the predictive value of UACR, hsCRP, and Nt-proBNP.
Main Results:
- UACR and hsCRP significantly predicted CEP across all risk groups, whereas Nt-proBNP showed predictive value primarily in higher-risk individuals.
- In the low-moderate risk group, UACR or hsCRP identified a subgroup (16%) experiencing one-third of CEPs.
- In patients with known cardiovascular disease or diabetes, combining UACR and Nt-proBNP identified a low-risk subgroup (52%) experiencing only 15% of CEPs.
- The addition of UACR and hsCRP (for low-moderate risk) or UACR and Nt-proBNP (for high-risk) significantly reclassified risk in 19% of the population.
Conclusions:
- UACR and hsCRP are valuable additions to cardiovascular risk prediction, particularly for refining risk assessment in low-to-moderate risk populations.
- Nt-proBNP may offer additional prognostic information in patients with established cardiovascular disease or diabetes.
- These biomarkers enhance the accuracy of risk stratification, potentially leading to more personalized preventive strategies.
Abstract:
The study aim was to determine whether urine albumin/creatinine ratio (UACR), high-sensitivity C-reactive protein (hsCRP) or N-terminal pro-brain natriuretic peptide (Nt-proBNP) added to risk prediction based on HeartScore and history of diabetes or cardiovascular disease. A Danish population sample of 2460 individuals was divided in three groups: 472 subjects receiving cardiovascular medication or having history of diabetes, prior myocardial infarction or stroke, 559 high-risk subjects with a 10-year risk of cardiovascular death above 5% as estimated by HeartScore, and 1429 low-moderate risk subjects with estimated risk below 5%. During the following 9.5 years the composite end point of cardiovascular death, non-fatal myocardial infarction or stroke (CEP) occurred in 204 subjects. CEP was predicted in all three groups by UACR (HRs: 2.1, 2.1 and 2.3 per 10-fold increase, all P<0.001) or by hsCRP (HRs: 1.9, 1.9 and 1.7 per 10-fold increase, all P<0.05), but not by Nt-proBNP (HRs: 1.1, 2.6 and 3.7 per 10-fold increase, last two P<0.001) (P<0.05 for interaction). In the low-moderate risk group, pre-specified gender adjusted (men/women) cutoff values of UACR> or =0.73/1.06 mg mmol(-1) or hsCRP> or =6.0/7.3 mg l(-1) identified a subgroup of 16% who experienced one-third of the CEPs. In the patient group, combined absence of high UACR and high Nt-proBNP> or =110/164 pg ml(-1) (men/women) identified a subgroup of 52% who experienced only 15% of the CEPs. Additional use of UACR and hsCRP in subjects with low-moderate risk and UACR and Nt-proBNP in subjects with known diabetes of cardiovascular disease changed HeartScore risk classification significantly in 19% of the population.
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