Abstract 14521: Biochemical Risk Markers and 10-Year Incidence of ASCVD - Independent Predictors, Improvement in Pooled Cohort Equation, and Risk Reclassification
Background: Given the notable drawbacks of the pooled cohort equation (PCE), the risk assessment working group (RAWG) of the ACC/AHA had specifically called for further research to identify novel risk markers that could improve the predictive ability of the PCE. We therefore explored the ability of biochemical risk markers in predicting 10-year risk of ASCVD as well as additional benefit of adding these markers to the PCE
Methods: We explored this clinically important question using the prospectively collected database of the Multi-ethnic Study of Atherosclerosis (MESA) that include subjects free of ASCVD at baseline and followed for more than 10 years. Cox proportional hazard model was used to evaluate the association between each biomarker and incidence of ASCVD. Additional benefit of each biomarker was explored using C-statistic, net reclassification index and integrated discrimination index
Results: Based on the principle used in the development of PCE, adults with age up to 79 years who had baseline measurement for each biomarker was included in this study. Of all biomarkers explored, only troponin T, NT-proBNP, homocysteine, interleukin-6, fibrinogen antigen, and microalbuminuria independently predicts 10-year risk of ASCVD (figure1). While all (except microalbuminuria) improves the discrimination slope of the model (p value for IDI ≤ 0.03), only NT-proBNP significantly improve C-statistic of the model (p=0.01). In addition, NT-proBNP and IL-6 offers potential in risk reclassification (p value for NRI <0.05)
Conclusion: We identified biochemical risk marker that predicts 10-year risk of ASCVD independent of traditional risk factors included in the PCE. These biomarkers could serve as additional information that can be used by clinician to supplement the PCE when deciding on statin therapy, especially in patients with intermediate risk. In addition, they could serve as potential variables to be considered in the improvement of the PCE for future guidelines
Author Disclosures: E. Akintoye: None. A. Briasoulis: None. L. Afonso: None.
- © 2016 by American Heart Association, Inc.