Circulating cardiac biomarkers improve risk stratification for incident cardiovascular disease in community dwelling populations.
Cardiac biomarkers
Community populations
Epidemiology
Incident cardiovascular disease
Risk stratification
Journal
EBioMedicine
ISSN: 2352-3964
Titre abrégé: EBioMedicine
Pays: Netherlands
ID NLM: 101647039
Informations de publication
Date de publication:
Aug 2022
Aug 2022
Historique:
received:
23
02
2022
revised:
28
06
2022
accepted:
01
07
2022
pubmed:
20
7
2022
medline:
17
8
2022
entrez:
19
7
2022
Statut:
ppublish
Résumé
Plasma cardiac markers may assist in prediction of incident cardiovascular disease. 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). 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. 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. 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.
Sections du résumé
BACKGROUND
BACKGROUND
Plasma cardiac markers may assist in prediction of incident cardiovascular disease.
METHODS
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
RESULTS
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
CONCLUSIONS
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
BACKGROUND
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.
Identifiants
pubmed: 35850010
pii: S2352-3964(22)00351-6
doi: 10.1016/j.ebiom.2022.104170
pmc: PMC9294489
pii:
doi:
Substances chimiques
Biomarkers
0
Peptide Fragments
0
Troponin I
0
Troponin T
0
Natriuretic Peptide, Brain
114471-18-0
Vitamin D
1406-16-2
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
104170Informations de copyright
Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of interests Zhenqiang Wu: 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 hsTnT assays and Abbott Laboratories for hsTnI assays. Anna P Pilbrow: Nil to disclose. Oi Wah Liew: Nil to disclose. Jenny P C Chong: Nil to disclose. John Sluyter: Support from Christchurch Heart Institute; travel costs for traveling to Christchurch to discuss ViDA study (give presentation) and methodology; costs for working with plasma aliquots from ViDA study. Data preparation, extraction of samples from freezer, data checking, arranging samples for couriering. Lynley K Lewis: Nil to disclose. Moritz Lasse: Nil to disclose. Chris M Frampton: Nil to disclose. Rod Jackson: Nil to disclose. Katrina Poppe: New Zealand Heart Foundation Senior fellowship to support salary; domestic travel to national meetings. Carlos Arturo Camargo Jr: Nil to disclose. Vicky Cameron A.: Nil to disclose. Robert Scragg: Health Research Council of New Zealand Application 10/400. Main government funder of health research in NZ. Accident Compensation Corporation. Main government insurer for health costs arising from injury. A Mark Richards: Roche Diagnostics In kind support for assays. Abbott Labs In kind support for assays. Roche Diagnostics advisory board fees.