Abstract 1637: Risk Factors and Prediction of Near-Term Myocardial Infarction in Apparently Healthy Men and Women
Background: Limited information exists on risk factors for near-term myocardial infarction (MI). We evaluated establised cardiovascular risk factors and putative circulating biomarkers as predictors for MI within 4 years of measurement.
Methods and Results: Established risk factors and 17 putative biomarkers, including inflammation-sensitive plasma proteins (C-reactive protein, fibrinogen, αl-antitrypsin, complement 3), apolipoproteins (A1, B, E, B/A1 ratio), markers of iron overload (iron, transferrin, transferrin saturation), creatinine, alkaline phosphatase, γ-glutamyl transpeptidase, and leukocytes (lymphocyte count, neutrophil count, neutrophil/lymphocyte ratio), were analyzed in a matched, nested case-control study (n=252+499) drawing upon 45,735 men and women participating in the Copenhagen City Heart Study and the Copenhagen General Population Study. Among women and men, only 19% and 50% of those with near-term MI were classified as high risk by Framingham risk score at baseline. After adjustment for traditional risk factors, odds ratios for near-term MI, comparing highest to lowest quintiles, were 2.85(95%CI:1.51–5.41;P=0.001) for αl-antitrypsin, 2.76(1.35–5.28;P=0.005) for C-reactive protein, 2.12(1.18 –3.82;P=0.01) for creatinine, 2.11(1.16 –3.85;P=0.01) for fibrinogen, and 0.33(0.17– 0.66;P=0.002) for iron. Corresponding odds ratio for all biomarkers combined was 8.56 (3.91–18.73;P<0.001).
Conclusions: We identified five biomarkers associated with increased near-term risk of MI independently of traditional risk factors. All putative biomarkers combined explained a 9-fold risk of near-term MI.