Abstract 17770: Comparison of Novel Markers in Prediction of Coronary Heart Disease Risk: the Rotterdam Study
Introduction: The utility of biomarkers and subclinical measures of atherosclerosis in prediction of coronary heart disease (CHD) risk and their added value above the traditional risk scoring algorithms such as the Framingham risk score (FRS) remains controversial.
Hypothesis: Incorporation of biomarkers or subclinical measures of atherosclerosis in the conventional risk prediction models improves CHD risk assessment in the general population.
Methods: The study included 6279 subjects from the population-based Rotterdam Study (mean age: 69 ± 8 years) who were free of CHD at baseline. Five biomarkers; N-terminal pro-brain natriuretic peptide(NT-proBNP), uric acid, C-reactive protein, von Willebrand factor, and creatinine, representative of multiple pathophysiological pathways, and three subclinical measures of atherosclerosis; coronary artery calcium (CAC), carotid intima media thickness, and ankle brachial index (ABI), were related to incident CHD over a median follow-up time of 6.8 years. We used Cox proportional hazard models to compute hazard ratios (HR) per standard deviation of the markers. The added predictive value of each variable beyond the FRS was assessed by calculating the improvement in C-statistic and the net reclassification index (NRI). Results: NT-proBNP (HR 1.49, 95% CI 1.37-1.63), CAC (HR 1.42, 95% CI 1.30-1.56), and ABI (HR 0.44, 95% CI 0.29-0.69) remained independent predictors of CHD after adjustment for conventional risk factors. The addition of NT-proBNP to the FRS model resulted in an increase in the C-statistic of 0.025 (CI: 0.013, 0.034) with a NRI of 8% (P < 0.0001). Corresponding values for CAC were 0.065 (CI: 0.042-0.083) and 12%(P <0.01) for improving the C-statistic and NRI, respectively. Addition of ABI to the FRS model did not yield a significant improvement in the C-statistic.
Conclusions: In this population-based study, we compared multiple novel markers for CHD risk in older subjects. NT-proBNP and CAC were strong predictors of incident CHD and improved risk stratification based on traditional risk scoring algorithms. Other well-known markers like C-reactive protein, uric acid, creatinine, and von Willebrand factor do not appear to have additional predictive value in older subjects.
- © 2010 by American Heart Association, Inc.