Red blood cell fatty acid patterns and acute coronary syndrome
Gregory C Shearer1, James V Pottala, John A Spertus
1Sanford Research/USD, Cardiovascular Health Research Center, Sioux Falls, SD, USA.
Insights
Red blood cell fatty acid (RBC-FA) profiles significantly improve acute coronary syndrome (ACS) risk prediction compared to standard factors alone. Combining RBC-FA profiles with standard risk factors offers the best discrimination for ACS cases.
Area of Science:
- Cardiovascular Disease Research
- Lipidomics
- Biomarker Discovery
Background:
- Coronary heart disease (CHD) risk assessment traditionally relies on standard risk factors.
- Novel lipidomic approaches, specifically red blood cell fatty acid (RBC-FA) profiles, are being explored for enhanced risk stratification.
- The diagnostic and prognostic utility of RBC-FA profiles in acute coronary syndrome (ACS) requires further elucidation.
Purpose of the Study:
- To evaluate the discriminatory power of RBC-FA profiles for acute coronary syndrome (ACS) cases versus controls.
- To compare the performance of RBC-FA profiles against established standard risk factors (SRF) in ACS discrimination.
- To assess the added value of incorporating RBC-FA profiles into existing risk prediction models.
Main Methods:
- Red blood cell fatty acid (RBC-FA) profiles were analyzed in 668 ACS cases and 680 matched controls.
- Multivariable logistic regression models were constructed using FA profiles (FA) and standard risk factors (SRF) on a derivation set and validated.
- Model performance was assessed using receiver operating characteristic (ROC) curves (c-statistics), misclassification rates, and calibration.
Main Results:
- RBC-FA profiles demonstrated superior discrimination of ACS cases compared to SRF (c-statistic 0.85 vs. 0.77, p=0.003).
- The addition of RBC-FA profiles significantly improved the combined model's discrimination (c-statistic 0.88 vs. 0.77, p<0.0001).
- The combined model achieved the lowest misclassification rate (20%) and acceptable calibration.
Conclusions:
- RBC-FA profiles significantly enhance the discrimination of ACS cases.
- Combining RBC-FA profiles with standard risk factors provides a more robust risk prediction model.
- Further research is warranted to explore the clinical utility of FA patterns in cardiovascular risk prediction.
Background:
Assessment of coronary heart disease (CHD) risk is typically based on a weighted combination of standard risk factors. We sought to determine the extent to which a lipidomic approach based on red blood cell fatty acid (RBC-FA) profiles could discriminate acute coronary syndrome (ACS) cases from controls, and to compare RBC-FA discrimination with that based on standard risk factors.
Methodology/Principal Findings:
RBC-FA profiles were measured in 668 ACS cases and 680 age-, race- and gender-matched controls. Multivariable logistic regression models based on FA profiles (FA) and standard risk factors (SRF) were developed on a random 2/3(rds) derivation set and validated on the remaining 1/3(rd). The area under receiver operating characteristic (ROC) curves (c-statistics), misclassification rates, and model calibrations were used to evaluate the individual and combined models. The FA discriminated cases from controls better than the SRF (c = 0.85 vs. 0.77, p = 0.003) and the FA profile added significantly to the standard model (c = 0.88 vs. 0.77, p<0.0001). Hosmer-Lemeshow calibration was poor for the FA model alone (p = 0.01), but acceptable for both the SRF (p = 0.30) and combined models (p = 0.22). Misclassification rates were 23%, 29% and 20% for FA, the SRF, and the combined models, respectively.
Conclusions/Significance:
RBC-FA profiles contribute significantly to the discrimination of ACS cases, especially when combined with standard risk factors. The utility of FA patterns in risk prediction warrants further investigation.
Related Concept Videos
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:38Inflammation