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Multiple marker approach to risk stratification in patients with stable coronary artery disease

Renate B Schnabel1, Andreas Schulz, C Martina Messow

  • 1Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany. schnabelr@gmx.de

European Heart Journal
|September 21, 2010
PubMed

Insights

Five biomarkers, including N-terminal-pro-B-type natriuretic peptide (NT-proBNP) and Growth-differentiation factor 15 (GDF-15), significantly predict cardiovascular events in stable angina patients. These markers offer improved risk prediction beyond traditional factors.

Area of Science:

  • Cardiology
  • Biomarker Discovery
  • Risk Prediction

Background:

  • Multimarker approaches for coronary artery disease risk prediction have shown inconsistent results.
  • Assessing biomarkers from distinct pathophysiological pathways is crucial for improving cardiovascular risk assessment.

Purpose of the Study:

  • To evaluate the predictive value of 12 diverse biomarkers for cardiovascular events in patients with stable angina.
  • To identify the most potent biomarkers for cardiovascular risk stratification in this population.

Main Methods:

  • A cohort of 1781 stable angina patients was analyzed over 3.6 years.
  • Twelve biomarkers reflecting inflammation, lipid metabolism, renal function, and cardiovascular remodeling were measured.
  • Cox proportional hazards models and C-indices were used to assess associations with non-fatal myocardial infarction and cardiovascular death.

Main Results:

  • N-terminal-pro-B-type natriuretic peptide (NT-proBNP), Growth-differentiation factor 15 (GDF-15), mid-regional-pro-atrial natriuretic peptide (MR-proANP), cystatin C, and mid-regional-pro-adrenomedullin (MR-proADM) were the strongest predictors.
  • These top five biomarkers demonstrated incremental predictive information beyond classical risk factors.
  • Combining the top markers showed a slight improvement in model fit but did not significantly enhance clinical risk prediction.

Conclusions:

  • NT-proBNP, GDF-15, MR-proANP, cystatin C, and MR-proADM are key predictors of cardiovascular outcomes in stable angina.
  • These biomarkers offer added value for risk stratification in patients with stable coronary artery disease.
  • While individually powerful, combining these markers did not substantially improve clinical risk prediction compared to single marker assessment.
Abstract

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