Abstract 15047: BioImage Study: Novel Biomarker Panel (CardioSCORE) for the Prediction of First Major Cardiovascular Events across the Full Range of Framingham Risk Scores

Abstract

Aim: We aim to assess the utility of an aggregate information obtain from panel of 7 proteins (CardioSCORE) in predicting major adverse cardiovascular events (MACE) across the range of Framingham Risk Scores (FRS). The CardioSCORE panel had been discovered and developed from myocardial infarction case-cohort studies as part of the Copenhagen General Population Study.

Methods: The study population is derived from the prospective BioImage Study designed to evaluate associations among imaging and circulating biomarkers and their ability to predict atherothrombotic events in asymptomatic at-risk subjects aged 55 years and above. The CardioSCORE is presented as a single numerical score based on the levels of Apolipoprotein A1, Apolipoprotein B, beta-2 microglobulin, carcinoembryonic antigen, high sensitivity C-reactive protein, lipoprotein(a), and transferrin.

Results: The study population consisted of 6,447 individuals (69±6 years, 44% males). The median (IQR) CardioSCORE was 4.6 (3.7-5.6). In a median follow-up of 2.5 years, 300 (4.6%) MACE was noted. In FRS, race, and CardioSCORE adjusted Cox regression analyses, the hazard ratio for MACE ranged from 1.50 (1.01-2.23), 1.95 (1.33-2.86), to 2.62 (1.81-3.79) folds with increasing quartiles (2-4 vs. 1^st quartile). The C statistics was 0.60 for models of MACE with FRS and race as predictors, which improved to 0.64 (p=0.0009) with addition of CardioSCORE. The net reclassification improvement with addition of CardioSCORE to model with FRS/race was 12%. Increasing CardioSCORE was independently associated with higher risk of MACE at all levels of FRS categories, with greatest discrimination in intermediate risk individuals (figure).

Conclusion: The novel biomarker panel (CardioSCORE) may be clinically useful for near-term risk prediction by discriminating across a full range of range of FRS. These findings need to be confirmed in additional prospective cohorts.