Single and multiple cardiovascular biomarkers in subjects without a previous cardiovascular event

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Manan Pareek
  • Deepak L. Bhatt
  • Muthiah Vaduganathan
  • Biering-Sørensen, Tor
  • Arman Qamar
  • Axel C.P. Diederichsen
  • Jacob Eifer Møller
  • Peter Hindersson
  • Margrét Leósdóttir
  • Martin Magnusson
  • Peter M. Nilsson
  • Michael H. Olsen

Aims To assess the incremental value of biomarkers, including N-terminal prohormone of brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-TnT), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), growth differentiation factor 15 (GDF-15), and procollagen type 1 N-terminal propeptide (P1NP), in predicting incident cardiovascular events and mortality among asymptomatic individuals from the general population, beyond traditional risk factors, including fasting glucose and renal function (cystatin C), medication use, and echocardiographic measures. Methods and results Prospective population-based cohort study of 1324 subjects without a previous cardiovascular event, who underwent baseline echocardiography and biomarker assessment between 2002 and 2006. The clinical endpoint was the composite of myocardial infarction, invasively treated stable/unstable ischemic heart disease, heart failure, stroke, or all-cause mortality. Predictive capabilities were evaluated using Cox proportional-hazards regression, Harrell's concordance index (C-index), and net reclassification improvement. Median age was 66 (interquartile range: 60-70) years, and 413 (31%) were female. During median 8.6 (interquartile range: 8.1-9.2) follow-up years, 368 (28%) composite events occurred. NT-proBNP, hs-TnT, GDF-15, and IL-6 were significantly associated with outcome, independently of traditional risk factors, medications, and echocardiography (p < 0.05 for all). Separate addition of NT-proBNP and GDF-15 to traditional risk factors, medications, and echocardiographic measurements provided significant improvements in discriminative ability (NT-proBNP: C-index 0.714 vs. 0.703, p = 0.03; GDF-15: C-index 0.721 vs. 0.703, p = 0.02). Both biomarkers remained significant predictors of outcome upon inclusion in the same model (p < 0.05 for both). Conclusions NT-proBNP and GDF-15 each enhance prognostication beyond traditional risk factors, glucose levels, renal function, and echocardiography in individuals without known cardiovascular disease.

OriginalsprogEngelsk
TidsskriftEuropean Journal of Preventive Cardiology
Vol/bind24
Udgave nummer15
Sider (fra-til)1648-1659
Antal sider12
ISSN2047-4873
DOI
StatusUdgivet - 2017
Eksternt udgivetJa

Bibliografisk note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by The Danish Diabetes Academy supported by the Novo Nordisk Foundation.

Publisher Copyright:
© European Society of Cardiology.

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