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Prognostic Value of Cardiovascular Biomarkers in the Population
Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Dept Cardiol, Hamburg, Germany.;Univ Heart & Vasc Ctr Hamburg, Dept Cardiol, Martinistr 52, D-20246 Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Ctr Populat Hlth Innovat, Hamburg, Germany.;German Ctr Cardiovasc Res, Partner Site Hamburg Kiel Lubeck, Hamburg, Germany.;Monash Univ, Sch Publ Hlth & Prevent Med, Dept Epidemiol & Prevent Med, Melbourne, Australia..ORCID iD: 0000-0002-9478-2757
Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Dept Cardiol, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Ctr Populat Hlth Innovat, Hamburg, Germany.;German Ctr Cardiovasc Res, Partner Site Hamburg Kiel Lubeck, Hamburg, Germany..
Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Dept Cardiol, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Ctr Populat Hlth Innovat, Hamburg, Germany..
Baylor Coll Med, Dept Med, Ctr Cardiometab Dis Prevent, Houston, TX 77030 USA..
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2024 (English)In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 331, no 22, p. 1898-1909Article in journal (Refereed) Published
Abstract [en]

Importance Identification of individuals at high risk for atherosclerotic cardiovascular disease within the population is important to inform primary prevention strategies. Objective To evaluate the prognostic value of routinely available cardiovascular biomarkers when added to established risk factors. Design, Setting, and Participants Individual-level analysis including data on cardiovascular biomarkers from 28 general population-based cohorts from 12 countries and 4 continents with assessments by participant age. The median follow-up was 11.8 years. Exposure Measurement of high-sensitivity cardiac troponin I, high-sensitivity cardiac troponin T, N-terminal pro-B-type natriuretic peptide, B-type natriuretic peptide, or high-sensitivity C-reactive protein. Main Outcomes and Measures The primary outcome was incident atherosclerotic cardiovascular disease, which included all fatal and nonfatal events. The secondary outcomes were all-cause mortality, heart failure, ischemic stroke, and myocardial infarction. Subdistribution hazard ratios (HRs) for the association of biomarkers and outcomes were calculated after adjustment for established risk factors. The additional predictive value of the biomarkers was assessed using the C statistic and reclassification analyses. Results The analyses included 164 054 individuals (median age, 53.1 years [IQR, 42.7-62.9 years] and 52.4% were women). There were 17 211 incident atherosclerotic cardiovascular disease events. All biomarkers were significantly associated with incident atherosclerotic cardiovascular disease (subdistribution HR per 1-SD change, 1.13 [95% CI, 1.11-1.16] for high-sensitivity cardiac troponin I; 1.18 [95% CI, 1.12-1.23] for high-sensitivity cardiac troponin T; 1.21 [95% CI, 1.18-1.24] for N-terminal pro-B-type natriuretic peptide; 1.14 [95% CI, 1.08-1.22] for B-type natriuretic peptide; and 1.14 [95% CI, 1.12-1.16] for high-sensitivity C-reactive protein) and all secondary outcomes. The addition of each single biomarker to a model that included established risk factors improved the C statistic. For 10-year incident atherosclerotic cardiovascular disease in younger people (aged <65 years), the combination of high-sensitivity cardiac troponin I, N-terminal pro-B-type natriuretic peptide, and high-sensitivity C-reactive protein resulted in a C statistic improvement from 0.812 (95% CI, 0.8021-0.8208) to 0.8194 (95% CI, 0.8089-0.8277). The combination of these biomarkers also improved reclassification compared with the conventional model. Improvements in risk prediction were most pronounced for the secondary outcomes of heart failure and all-cause mortality. The incremental value of biomarkers was greater in people aged 65 years or older vs younger people. Conclusions and Relevance Cardiovascular biomarkers were strongly associated with fatal and nonfatal cardiovascular events and mortality. The addition of biomarkers to established risk factors led to only a small improvement in risk prediction metrics for atherosclerotic cardiovascular disease, but was more favorable for heart failure and mortality.

Place, publisher, year, edition, pages
American Medical Association (AMA), 2024. Vol. 331, no 22, p. 1898-1909
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Cardiology and Cardiovascular Disease
Identifiers
URN: urn:nbn:se:uu:diva-541161DOI: 10.1001/jama.2024.5596ISI: 001225478900001PubMedID: 38739396OAI: oai:DiVA.org:uu-541161DiVA, id: diva2:1908800
Available from: 2024-10-29 Created: 2024-10-29 Last updated: 2025-02-10Bibliographically approved

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Eggers, Kai M.Giedraitis, VilmantasHedberg, Pär

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Neumann, Johannes TobiasEggers, Kai M.Giedraitis, VilmantasHedberg, PärIacoviello, LiciaZeller, Tanja
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CardiologyClinical geriatricsCentre for Clinical Research, County of Västmanland
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Cardiology and Cardiovascular Disease

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