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Circulating cardiac biomarkers improve risk stratification for incident cardiovascular disease in community dwelling
Zhenqiang Wu1, Anna P Pilbrow2, Oi Wah Liew3
1School of Population Health, University of Auckland, Auckland, New Zealand.
Insights
Plasma cardiac biomarkers like troponins and NT-proBNP significantly predict cardiovascular disease risk in primary care. These markers improve risk assessment beyond established factors for better cardiovascular disease (CVD) prediction.
Area of Science:
- Cardiology
- Biomarkers
- Preventive Medicine
Background:
- Plasma cardiac markers show potential for predicting incident cardiovascular disease (CVD).
- Established risk factors are used in primary care for CVD risk assessment.
Purpose of the Study:
- To assess the incremental value of cardiac troponins (T and I) and NT-proBNP.
- To determine if these markers improve the PREDICT score for incident CVD in primary care.
Main Methods:
- Utilized data from 4102 asymptomatic participants in the Vitamin D (ViDA) trial.
- Corroborated findings in 2528 participants from the Heart of Victoria Longitudinal Study (HVOLS).
- Assessed hazard ratios and improved discrimination (C-statistic) with marker addition to the PREDICT score.
Main Results:
- Increased plasma concentrations of hs-cTnI, hs-cTnT, and NT-proBNP were associated with significantly higher hazard ratios for cardiovascular events.
- The C-statistic for predicting the primary endpoint improved from 0.755 to 0.771 (p = 0.01).
- Cardiac marker data reclassified risk upwards in 6.7% and downwards in 3.3% of patients.
Conclusions:
- Plasma cardiac biomarkers robustly predict increased hazard of incident CVD, independent of established risk factors.
- These markers reproducibly enhance CVD risk assessment in community-dwelling populations.
- Cardiac markers may augment cardiovascular risk assessment in primary care settings.
Background:
Plasma cardiac markers may assist in prediction of incident cardiovascular disease.
Methods:
The incremental value of cardiac Troponins (T and I) and NT-proBNP added to risk factors in the PREDICT score for incident cardiovascular disease (CVD) in primary care, was assessed in 4102 asymptomatic participants in a randomised controlled trial of Vitamin D (ViDA). Findings were corroborated in 2528 participants in a separate community-based observational registry of CVD-free volunteers (HVOLS).
Findings:
Hazard ratios for first cardiovascular events adjusted for PREDICT risk factors, comparing fifth to first quintiles of marker plasma concentrations, were 2.57 (95% CI 1.47-4.49); 3.01 (1.66-5.48) and 3.38 (2.04-5.60) for hs-cTnI, hs-cTnT and NT-proBNP respectively. The C statistic for discrimination of the primary endpoint increased from 0.755 to 0.771 (+0.016, p = 0.01). Cardiac marker data correctly reclassified risk upwards in 6.7% of patients and downwards in 3.3%. These findings were corroborated by results from HVOLS.
Interpretation:
Increments in plasma cardiac biomarkers robustly and reproducibly predicted increased hazard of incident CVD, independent of established risk factors, in two community-dwelling populations. Cardiac markers may augment risk assessment for onset of CVD in primary care.
Funding:
ViDA was funded by the Health Research Council of New Zealand (grant 10/400) and the Accident Compensation Corporation. HVOLS was funded by the Health Research Council of NZ Programme Grants (grants 02/152 and 08/070) and by grants from the Heart Foundation of NZ and the Christchurch Heart Institute Trust. Roche Diagnostics provided in-kind support for NT-proBNP and hs-cTnT assays and Abbott Laboratories for hs-cTnI assays.
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