Biomarkers versus traditional risk factors to predict cardiovascular events in very old adults: cross-validated prospective cohort study
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Published on: January 28, 2014
Bert Vaes1, Paulien Indestege2, Tinne Serneels2
1Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium bert.vaes@kuleuven.be.
Insights
New cardiovascular risk models were tested in very old adults. N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) significantly improved prediction of cardiovascular events, offering a practical tool for clinicians.
Area of Science:
- Gerontology and Cardiovascular Medicine
- Biomarker Discovery and Validation
Background:
- Cardiovascular disease (CVD) risk prediction in very old adults (≥80 years) is challenging due to limited data and unique physiological changes.
- Traditional risk factors may not adequately capture the complex risk profile in this population.
Purpose of the Study:
- To evaluate novel cardiovascular (CV) risk prediction models in elderly individuals with and without pre-existing CVD.
- To assess the added value of biomarkers, specifically N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and high-sensitivity C-reactive protein (hs-CRP), in these models.
Main Methods:
- A cross-validated prospective cohort study design was employed, utilizing the BELFRAIL and Leiden 85-plus cohorts.
- Models incorporating traditional risk factors alone, biomarkers alone, and a combination of both were compared to predict 3-year CV morbidity and mortality.
- Statistical analyses included competing-risk analysis, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI).
Main Results:
- Traditional risk factors alone demonstrated poor predictive performance for CV outcomes in very old adults.
- Adding NT-pro-BNP to traditional risk factors significantly improved CV risk prediction in individuals without prior CVD (NRI=0.56, relative IDI=4.01).
- In patients with existing CVD, the addition of NT-pro-BNP and hs-CRP enhanced prediction (NRI=0.38, relative IDI=0.53). NT-pro-BNP also showed strong standalone predictive value.
Conclusions:
- Novel risk models incorporating biomarkers, particularly NT-pro-BNP, offer superior cardiovascular risk prediction in very old adults compared to traditional factors alone.
- NT-pro-BNP demonstrates significant added predictive value and potential as a standalone predictor in this age group.
- These findings support the clinical utility of easily applicable biomarker-based strategies for CV risk assessment in the elderly.
Objectives:
To test new cardiovascular (CV) risk models in very old adults with and without a history of CV disease (CVD), based on traditional risk factors and biomarkers.
Design:
Cross-validated prospective cohort study. The models were tested in the BELFRAIL Study and externally validated in the Leiden 85-plus Study.
Setting:
General practice, Belgium and The Netherlands.
Participants:
The BELFRAIL cohort consisted of 266 patients aged 80 years or older without a history of CVD and 260 with a history of CVD. The Leiden 85-plus Study consisted of 264 patients aged 85 years without a history of CVD and 282 with a history of CVD.
Outcome Measures:
The model with traditional risk factors and biomarkers, as well as the model using only biomarkers, was compared with the model with only traditional risk factors to predict 3-year CV morbidity and mortality. A competing-risk analysis was performed, and the continuous net reclassification improvement (NRI), integrated discrimination improvement (IDI) and net benefit were used to compare the predictive value of the different models.
Results:
Traditional risk factors poorly predicted CV mortality and morbidity. In participants without a history of CVD, adding N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) improved the prediction (NRI 0.56 (95% CI 0.16 to 0.99) and relative IDI 4.01 (95% CI 2.19 to 6.28)). In participants with a history of CVD, the NRI with the addition of NT-pro-BNP and high-sensitivity C reactive protein was 0.38 (95% CI 0.09 to 0.70), and the relative IDI was 0.53 (95% CI 0.23 to 0.90). Moreover, in participants without a history of CVD, NT-pro-BNP performed well as a stand-alone predictor (NRI 0.32 (95% CI -0.12 to 0.74) and relative IDI 3.44 (95% CI 1.56 to 6.09)).
Conclusions:
This study tested new risk models to predict CV morbidity and mortality in very old adults. Especially, NT-pro-BNP showed a strong added predictive value. This opens perspectives for clinicians who are in need of an easily applicable strategy for CV risk prediction in very old adults.
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