Large-Scale Proteomics-Based Risk Score for the Prediction of Incident Cardio-Kidney-Metabolic Disease Risk

Cardio-kidney-metabolic (CKM) disease represents a significant public health challenge. While proteomics-based risk scores (ProtRS) enhance cardiovascular risk prediction, their utility in improving risk prediction for a composite CKM outcome beyond traditional risk factors remains unknown.

We analyzed 23 815 UK Biobank participants without baseline CKM disease, defined by International Classification of Diseases-Tenth Revision codes as cardiovascular disease (coronary artery disease, heart failure, stroke, peripheral arterial disease, atrial fibrillation/flutter), kidney disease (chronic kidney disease or end-stage renal disease), or metabolic disease (type 2 diabetes or obesity). The sample was randomly divided into ProtRS training (70%, n=16 671) and validation (30%, n=7144) cohorts. A least absolute shrinkage and selection operator-based Cox regression model of 2913 Olink-based proteins was utilized to develop the ProtRS in the training cohort. We then assessed the association of the ProtRS with incident CKM disease risk in the validation cohort with competing-risk regression after adjusting for traditional risk factors and evaluated its ability to discriminate incident CKM disease risk with C-indices.

The study sample had a mean age of 56.1 years; 44% were men, and 94% were White. Over a median follow-up of 13.5 years, 3235 and 1407 incident CKM disease events occurred in the training and validation cohorts, respectively. A ProtRS based on the weighted sum of the 238 least absolute shrinkage and selection operator-selected proteins was significantly associated with incident CKM disease risk (subdistribution hazard ratio per 1-SD, 1.87 [95% CI, 1.73-2.03]; P<0.001) in the validation cohort after adjustment for traditional risk factors. The addition of the ProtRS to a traditional risk factor model significantly improved incident CKM disease risk discrimination beyond the traditional risk factor model (C-index, 0.73 [0.72-0.74] versus 0.71 [0.69-0.72]; ΔC-index, 0.03 [0.02-0.04]).

A ProtRS was independently associated with incident CKM disease risk and improved risk prediction beyond traditional risk factors in a population free of CKM disease at baseline.