Combining Biomarkers and Imaging for Short-Term Assessment of Cardiovascular Disease Risk in Apparently Healthy Adults.

Abstract

Background Current strategies for cardiovascular disease (CVD) risk assessment focus on 10-year or longer timeframes. Shorter-term CVD risk is also clinically relevant, particularly for high-risk occupations, but is under-investigated. Methods and Results We pooled data from participants in the ARIC (Atherosclerosis Risk in Communities study), MESA (Multi-Ethnic Study of Atherosclerosis), and DHS (Dallas Heart Study), free from CVD at baseline (N=16 581). Measurements included N-terminal pro-B-type natriuretic peptide (>100 pg/mL prospectively defined as abnormal); high-sensitivity cardiac troponin T (abnormal >5 ng/L); high-sensitivity C-reactive protein (abnormal >3 mg/L); left ventricular hypertrophy by ECG (abnormal if present); carotid intima-media thickness, and plaque (abnormal >75th percentile for age and sex or presence of plaque); and coronary artery calcium (abnormal >10 Agatston U). Each abnormal test result except left ventricular hypertrophy by ECG was independently associated with increased 3-year risk of global CVD (myocardial infarction, stroke, coronary revascularization, incident heart failure, or atrial fibrillation), even after adjustment for traditional CVD risk factors and the other test results. When a simple integer score counting the number of abnormal tests was used, 3-year multivariable-adjusted global CVD risk was increased among participants with integer scores of 1, 2, 3, and 4, by ≈2-, 3-, 4.5- and 8-fold, respectively, when compared with those with a score of 0. Qualitatively similar results were obtained for atherosclerotic CVD (fatal or non-fatal myocardial infarction or stroke). Conclusions A strategy incorporating multiple biomarkers and atherosclerosis imaging improved assessment of 3-year global and atherosclerotic CVD risk compared with a standard approach using traditional risk factors.

• Authors: Maria Odette Gore, Colby R Ayers, Amit Khera, Christopher R deFilippi, Thomas J Wang, Stephen L Seliger, Vijay Nambi, Elizabeth Selvin, Jarett D Berry, W Gregory Hundley, Matthew Budoff, Philip Greenland, Mark H Drazner, Christie M Ballantyne, Benjamin D Levine, James A de Lemos
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 9 Issue 15 Pg. e015410 (08 04 2020) ISSN: 2047-9980 [Electronic] England
• PMID: 32698652 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Peptide Fragments
• TNNT2 protein, human
• Troponin T
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain
• C-Reactive Protein

Topics

• Aged
• Aged, 80 and over
• Biomarkers (blood)
• C-Reactive Protein (analysis)
• Cardiovascular Diseases (diagnostic imaging, etiology)
• Carotid Intima-Media Thickness
• Electrocardiography
• Female
• Humans
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Risk Assessment
• Risk Factors
• Troponin T (blood)