Multimodality Strategy for Cardiovascular Risk Assessment: Performance in 2 Population-Based Cohorts

Area of Science:

• Cardiology
• Preventive Medicine
• Biomarker Discovery

Background:

• Current cardiovascular disease (CVD) risk assessment tools have limitations in performance and scope, particularly for atherosclerotic CVD (ASCVD).
• There is a need for improved risk stratification strategies in asymptomatic adults to prevent CVD events.

Purpose of the Study:

• To evaluate a novel multimodality testing strategy for improved global and atherosclerotic CVD risk assessment.
• To determine if combining multiple biomarkers enhances risk prediction in individuals without established CVD.

Main Methods:

• Utilized data from the Multi-Ethnic Study of Atherosclerosis (MESA) and Dallas Heart Study (DHS) cohorts.
• Assessed left ventricular hypertrophy (ECG), coronary artery calcium, N-terminal pro B-type natriuretic peptide, high-sensitivity cardiac troponin T, and high-sensitivity C-reactive protein.
• Analyzed associations with global composite CVD outcomes and ASCVD events over 10 years, adjusting for traditional risk factors.

Main Results:

• Each biomarker independently predicted global CVD events.
• Integrating the five tests improved risk prediction model performance (c-statistic from 0.74 to 0.79, P=0.001) with significant reclassification improvements.
• A simple integer score based on abnormal tests showed a graded association with increased global CVD risk, replicated in DHS and for ASCVD outcomes.

Conclusions:

• A multimodality testing strategy incorporating ECG-derived left ventricular hypertrophy, coronary artery calcium, NT-proBNP, hs-cTnT, and hs-CRP significantly enhances CVD and ASCVD risk assessment.
• This approach offers a more comprehensive risk stratification for adults without known CVD.
• The findings support the clinical utility of combining diverse biomarkers for improved cardiovascular risk prediction.