Abstract 12567: Contribution of Emerging Risk Markers to Global Cardiovascular Risk Assessment

Abstract

Background: The differential predictive ability of emerging risk markers for components of cardiovascular disease (CVD) remains unclear. Objective: To study the added predictive value of a range of newer risk markers, above the traditional risk factors, for various cardiovascular outcomes. Design: The study comprised 6,498 participants (69.4±8.4 years) from the Rotterdam Study. We assessed the improvements in cardiovascular risk predictions above the traditional risk factors with a range of newer risk markers including sub-clinical measures of atherosclerosis, emerging biomarkers, and markers of cardiac function. Main Outcome Measures understudy were incident CVD, heart failure (HF), and ischemic stroke.

Results: Coronary artery calcium (CAC), carotid intima-media thickness (IMT), and amino-terminal pro-B-type natriuretic peptide (NT-proBNP) improved CVD risk prediction above the traditional risk factors. CAC increased the c-statistic by 0.024 and provided 9.7% net reclassification improvement (NRI). IMT increased the c-statistic by 0.008 and yielded 2.7% NRI. Corresponding results for NT-proBNP were 0.022 increase in the c-statistic and 4.7% NRI. Among subjects at intermediate risk for CVD by traditional risk factors, CAC, IMT, and NT-proBNP provided NRIs of 28.6%, 14.2%, and 27.7% respectively. The substantial improvement in CVD risk prediction by CAC was not paired by equitable contributions to HF or ischemic stroke risk predictions. The added predictive value of IMT for both HF and ischemic stroke was modest. NT-proBNP improved risk predictions for all cardiovascular outcomes. The added predictive value of other markers was marginal and varied per outcome.

Conclusions: CAC, IMT, and NT-proBNP provided the best increment in CVD risk prediction above the traditional risk factors. The substantial gain in CVD risk prediction by addition of CAC was not accompanied by equitable contributions to HF or ischemic stroke risk predictions. While the added value of IMT in prediction of various cardiovascular outcomes was small, NT-proBNP considerably improved risk predictions for all outcomes.