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Prediction of Cardiovascular Disease Risk by Cardiac Biomarkers in 2 United Kingdom Cohort Studies: Does Utility
Paul Welsh1, Carole Hart1, Olia Papacosta1
1From the Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre (P.W., D.P., N.S.), Institute of Health and Wellbeing (C.H., G.W.), and Robertson Centre for Biostatistics (A.M., H.M.), University of Glasgow, Glasgow, United Kingdom; Department of Primary Care and Population Health, University College London, London, United Kingdom (O.P., S.R., P.W., G.W.); and Helmsley Medical Centre, Helmsley, York, United Kingdom (M.U.).
Insights
Cardiac biomarkers like NT-proBNP and troponin T can improve cardiovascular disease risk prediction, especially when using specific risk thresholds for treatment decisions.
Area of Science:
- Cardiology
- Biomarker Research
- Preventive Medicine
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality.
- Accurate risk prediction is crucial for timely intervention.
- Established risk scores have limitations in identifying all at-risk individuals.
Purpose of the Study:
- To evaluate the predictive ability of NT-proBNP, high-sensitivity troponin T, and midregional pro adrenomedullin for CVD events.
- To determine if these biomarkers improve existing CVD risk prediction models.
- To assess the impact of biomarker addition on clinical decision-making for preventive treatments.
Main Methods:
- Utilized data from the British Regional Heart Study (BRHS) and MIDSPAN Family Study (MFS).
- Employed Cox regression models adjusted for classical risk factors.
- Assessed improvements in C-index and risk reclassification using NT-proBNP and other biomarkers.
Main Results:
- NT-proBNP and high-sensitivity troponin T generally associated with increased CVD risk.
- NT-proBNP significantly improved risk prediction in the BRHS cohort.
- Improvements in risk classification were threshold-dependent, particularly for NT-proBNP and troponin T.
Conclusions:
- Cardiac biomarkers, notably NT-proBNP, can enhance CVD risk assessment.
- The clinical utility of adding biomarkers depends on the chosen risk threshold for initiating preventive therapies.
- Further research may refine biomarker integration into clinical practice for personalized CVD prevention.
Abstract:
We tested the predictive ability of cardiac biomarkers N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T, and midregional pro adrenomedullin for cardiovascular disease (CVD) events using the British Regional Heart Study (BRHS) of men aged 60 to 79 years, and the MIDSPAN Family Study (MFS) of men and women aged 30 to 59 years. They included 3757 and 2226 participants, respectively, and during median 13.0 and 17.3 years follow-up the primary CVD event rates were 16.6 and 5.3 per 1000 patient-years, respectively. In Cox models adjusted for basic classical risk factors, 1 SD increases in log-transformed NT-proBNP, high-sensitivity troponin T, and midregional pro adrenomedullin were generally associated with increased primary CVD risk in both the studies (P<0.006) except midregional pro adrenomedullin in MFS (P=0.10). In BRHS, QRISK2 risk factors yielded a C-index of 0.657, which was improved by 0.017 (P=0.005) by NT-proBNP, but not by other biomarkers. Using 28% 14-year risk as a proxy for 20% 10-year risk, NT-proBNP improved risk classification for primary CVD cases (case net reclassification index, 5.9%; 95% confidence interval, 2.8%-9.2%), but only improved classification of noncases at a 14% 14-year risk threshold (4.6%; 2.9%-6.3%). In MFS, ASSIGN risk factors yielded a C-index of 0.752 for primary CVD; none of the cardiac biomarkers improved the C-index. Improvements in risk classification were only seen using NT-proBNP and high-sensitivity troponin T among cases using the 28% 14-year risk threshold (4.7%; 1.0%-9.2% and 2.6%; 0.0%-5.8%, respectively). In conclusion, the improvement in treatment allocation gained by adding cardiac biomarkers to risk scores seems to depend on the risk threshold chosen for commencing preventative treatments.
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