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BackgroundCurrent strategies for cardiovascular disease (CVD) risk assessment among adults without known CVD are limited by suboptimal performance and a narrow focus on only atherosclerotic CVD (ASCVD). We hypothesized that a strategy combining promising biomarkers across multiple different testing modalities would improve global and atherosclerotic CVD risk assessment among individuals without known CVD.MethodsWe included participants from MESA (Multi-Ethnic Study of Atherosclerosis) (n=6621) and the Dallas Heart Study (n=2202) who were free from CVD and underwent measurement of left ventricular hypertrophy by ECG, coronary artery calcium, N-terminal pro B-type natriuretic peptide, high-sensitivity cardiac troponin T, and high-sensitivity C-reactive protein. Associations of test results with the global composite CVD outcome (CVD death, myocardial infarction, stroke, coronary or peripheral revascularization, incident heart failure, or atrial fibrillation) and ASCVD (fatal or nonfatal myocardial infarction or stroke) were assessed over >10 years of follow-up. Multivariable analyses for the primary global CVD end point adjusted for traditional risk factors plus statin use and creatinine (base model).ResultsEach test result was independently associated with global composite CVD events in MESA after adjustment for the components of the base model and the other test results (P

Introduction: N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) associate with structural heart disease and heart failure risk in individuals without known CVD. However, few data are available regarding whether factors influencing levels of these two biomarkers are similar or distinct. We performed serial measurements of NT-proBNP and hs-cTnT in a contemporary multi-ethnic cohort with extensive phenotyping, with the goal of identifying their respective biological determinants in a population without known or suspected CVD. Methods: We evaluated 3254 participants of Dallas Heart Study who had NT-proBNP and hs-cTnT measured and were free from clinical CVD in each of its two phases (2000-2002 and 2007-2009). Variables collected included demographic and risk factors, body composition via DEXA and MRI, coronary artery calcium (CAC) by CT, and cardiac dimensions and function by cMRI. Linear regression was used to identify associations of these factors with each biomarker at baseline and with changes in biomarkers over follow-up. Results: NT-proBNP and hs-cTnT were poorly correlated at baseline (Spearman rho 0.043), with only moderate correlation between change values (rho 0.179). hs-cTnT positively associated and NT-proBNP inversely associated with male gender and black race (Table). NT-proBNP was more strongly associated with measures of body composition than hs-cTnT. At baseline, both NT-proBNP and hs-cTnT associated with LVEDV and wall thickness, but only NT-proBNP associated with LA size. Changes in cardiac dimensions between phases were associated with changes in NT-proBNP but not hs-cTnT (Table). Conclusions: Among individuals without CVD in the general population, NT-proBNP and hs-cTnT are non-redundant biomarkers that are differentially associated with demographic and cardiac factors. These findings indicate that hs-cTnT and NT-proBNP may reflect different pathophysiological pathways. [ABSTRACT FROM AUTHOR]

Obesity and decreased cardiorespiratory fitness (CRF) are independent risk factors for mortality, but higher CRF may minimize the adverse impacts of obesity. Using deep phenotyping, we explored what blood-based and imaging biomarkers were associated with higher CRF among both non-obese and obese individuals in a large multiethnic epidemiological cohort to better understand the biology of the fat but fit phenotype. We performed a cross-sectional analysis of participants enrolled in the Dallas Heart Study between 2007 to 2009 without cardiovascular disease, HIV, cancer, or end-stage renal disease. A total of 2351 individuals were divided into four groups by obesity status (BMI < or ≥30 kg/m2) and CRF (unfit or fit defined as >25th percentile by age and sex, measured using a submaximal treadmill test). Multivariate logistic regression analyses were used to compare circulating biomarkers of cardiometabolic risk, cardiac structure by cardiac magnetic resonance, and adipose depots by dual-energy X-ray absorptiometry between these groups. There were 1052 non-obese and fit, 227 non-obese and unfit, 716 obese and fit, and 356 obese and unfit persons. After adjustment for sex, race, and BMI, factors that were independently associated with fitness in the obese group (versus obese and unfit group) were lower pulse rate (OR, 0.56; 95% CI 0.44-0.71), higher end-diastolic volume indexed to body-surface-area (OR, 1.37; 95% CI 1.06-1.77), and lower subcutaneous fat indexed to body-surface-area (OR, 0.57; 95% CI 0.34-0.96). Lower pulse rate and subcutaneous fat were also associated with being more fit in the non-obese; but contrary to the obese, no cardiac structural measures were statistically significant. These findings suggest that the fat but fit phenotype is characterized by a lower resting pulse, less subcutaneous fat, and a higher left ventricular end-diastolic volume. Being fit is linked to beneficial physiological and cardiovascular changes, irrespective of BMI. [ABSTRACT FROM AUTHOR]