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Published on: January 28, 2020
Biomarkers of Vascular Inflammation for Cardiovascular Risk Prognostication: A Meta-Analysis
Alexios S Antonopoulos1, Andreas Angelopoulos2, Paraskevi Papanikolaou2
11(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece; RDM Division of Cardiovascular Medicine, University of Oxford, United Kingdom.
Insights
Biomarkers of vascular inflammation significantly improve cardiovascular risk prediction for major adverse cardiovascular events. These markers enhance prognostication beyond traditional clinical factors, aiding in better patient stratification.
Area of Science:
- Cardiology
- Biomarker Research
- Vascular Inflammation
Background:
- Biomarkers of vascular inflammation are recommended for coronary heart disease (CHD) risk stratification.
- Current clinical risk factors may not fully capture individual patient risk for cardiovascular events.
Purpose of the Study:
- To systematically evaluate the added prognostic value of vascular inflammation biomarkers for cardiovascular risk assessment.
- To determine if these biomarkers improve risk prediction beyond established clinical factors.
Main Methods:
- A systematic review and meta-analysis of cohort studies published in MEDLINE.
- Included studies assessed common circulating and imaging biomarkers of vascular inflammation in patients without known CHD.
- Primary endpoint was the difference in c-index (Δ[c-index]) for major adverse cardiovascular events (MACEs) and mortality.
Main Results:
- 39 studies (175,778 individuals) were included.
- Vascular inflammation biomarkers showed added prognostic value for composite endpoints and MACEs (Δ[c-index]% 2.9 and 3.1, respectively).
- Coronary CT angiography-derived biomarkers, particularly high-risk plaques and perivascular adipose tissue, demonstrated the highest added value for MACEs.
Conclusions:
- Biomarkers of vascular inflammation significantly enhance risk discrimination for cardiovascular events.
- These markers provide incremental prognostic information, improving cardiovascular risk assessment in clinical practice.
Objectives:
The purpose of this study was to systematically explore the added value of biomarkers of vascular inflammation for cardiovascular prognostication on top of clinical risk factors.
Background:
Measurement of biomarkers of vascular inflammation is advocated for the risk stratification for coronary heart disease (CHD).
Methods:
We systematically explored published reports in MEDLINE for cohort studies on the prognostic value of common biomarkers of vascular inflammation in stable patients without known CHD. These included common circulating inflammatory biomarkers (ie, C-reactive protein, interleukin-6 and tumor necrosis factor-a, arterial positron emission tomography/computed tomography and coronary computed tomography angiography-derived biomarkers of vascular inflammation, including anatomical high-risk plaque features and perivascular fat imaging. The main endpoint was the difference in c-index (Δ[c-index]) with the use of inflammatory biomarkers for major adverse cardiovascular events (MACEs) and mortality. We calculated I2 to test heterogeneity. This study is registered with PROSPERO (CRD42020181158).
Results:
A total of 104,826 relevant studies were screened and a final of 39 independent studies (175,778 individuals) were included in the quantitative synthesis. Biomarkers of vascular inflammation provided added prognostic value for the composite endpoint and for MACEs only (pooled estimate for Δ[c-index]% 2.9, 95% CI: 1.7-4.1 and 3.1, 95% CI: 1.8-4.5, respectively). Coronary computed tomography angiography-related biomarkers were associated with the highest added prognostic value for MACEs: high-risk plaques 5.8%, 95% CI: 0.6 to 11.0, and perivascular adipose tissue (on top of coronary atherosclerosis extent and high-risk plaques): 8.2%, 95% CI: 4.0 to 12.5). In meta-regression analysis, the prognostic value of inflammatory biomarkers was independent of other confounders including study size, length of follow-up, population event incidence, the performance of the baseline model, and the level of statistical adjustment. Limitations in the published literature include the lack of reporting of other metrics of improvement of risk stratification, the net clinical benefit, or the cost-effectiveness of such biomarkers in clinical practice.
Conclusions:
The use of biomarkers of vascular inflammation enhances risk discrimination for cardiovascular events.
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