Prognostic Value of Cardiovascular Biomarkers in the Population

Area of Science:

• Cardiology
• Preventive Medicine
• Biomarker Research

Background:

• Identifying individuals at high risk for atherosclerotic cardiovascular disease (ASCVD) is crucial for effective primary prevention strategies.
• Established risk factors are used to assess ASCVD risk, but improved risk stratification is needed.

Purpose of the Study:

• To evaluate the prognostic value of routinely available cardiovascular biomarkers when added to established risk factors for ASCVD.
• To assess the incremental predictive value of specific biomarkers for ASCVD and related outcomes.

Main Methods:

• Individual-level data from 28 population-based cohorts across 12 countries were analyzed.
• High-sensitivity cardiac troponin I, high-sensitivity cardiac troponin T, NT-proBNP, BNP, and hs-CRP were measured.
• Associations with incident ASCVD, all-cause mortality, heart failure, ischemic stroke, and myocardial infarction were evaluated using Cox regression and reclassification analyses.

Main Results:

• All measured biomarkers were significantly associated with incident ASCVD and secondary outcomes.
• Adding single biomarkers to established risk factors improved risk prediction (C statistic).
• A combination of hs-cTnI, NT-proBNP, and hs-CRP improved 10-year ASCVD prediction in individuals <65 years and showed greater improvement for heart failure and all-cause mortality, particularly in those aged ≥65 years.

Conclusions:

• Cardiovascular biomarkers are strongly associated with cardiovascular events and mortality.
• While biomarkers offer a modest improvement in ASCVD risk prediction, their value is more significant for predicting heart failure and mortality.
• Biomarker incorporation enhances risk prediction models, especially in older populations and for specific cardiovascular outcomes.