1. Combining Biomarkers and Imaging for Short‐Term Assessment of Cardiovascular Disease Risk in Apparently Healthy Adults
- Author
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Gore, Maria Odette, Ayers, Colby R, Khera, Amit, deFilippi, Christopher R, Wang, Thomas J, Seliger, Stephen L, Nambi, Vijay, Selvin, Elizabeth, Berry, Jarett D, Hundley, W Gregory, Budoff, Matthew, Greenland, Philip, Drazner, Mark H, Ballantyne, Christie M, Levine, Benjamin D, and de Lemos, James A
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Research ,Aging ,Heart Disease - Coronary Heart Disease ,Prevention ,Cardiovascular ,Heart Disease ,Atherosclerosis ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Good Health and Well Being ,Aged ,Aged ,80 and over ,Biomarkers ,C-Reactive Protein ,Cardiovascular Diseases ,Carotid Intima-Media Thickness ,Electrocardiography ,Female ,Humans ,Male ,Middle Aged ,Natriuretic Peptide ,Brain ,Peptide Fragments ,Risk Assessment ,Risk Factors ,Troponin T ,carotid intima-media thickness ,coronary artery calcium ,high-sensitivity cardiac troponin T ,high-sensitivity C-reactive protein ,N-terminal pro B-type natriuretic peptide ,plaque ,N‐terminal pro B‐type natriuretic peptide ,carotid intima‐media thickness ,high‐sensitivity C‐reactive protein ,high‐sensitivity cardiac troponin T ,Cardiorespiratory Medicine and Haematology ,Cardiovascular medicine and haematology - Abstract
Background Current strategies for cardiovascular disease (CVD) risk assessment focus on 10-year or longer timeframes. Shorter-term CVD risk is also clinically relevant, particularly for high-risk occupations, but is under-investigated. Methods and Results We pooled data from participants in the ARIC (Atherosclerosis Risk in Communities study), MESA (Multi-Ethnic Study of Atherosclerosis), and DHS (Dallas Heart Study), free from CVD at baseline (N=16 581). Measurements included N-terminal pro-B-type natriuretic peptide (>100 pg/mL prospectively defined as abnormal); high-sensitivity cardiac troponin T (abnormal >5 ng/L); high-sensitivity C-reactive protein (abnormal >3 mg/L); left ventricular hypertrophy by ECG (abnormal if present); carotid intima-media thickness, and plaque (abnormal >75th percentile for age and sex or presence of plaque); and coronary artery calcium (abnormal >10 Agatston U). Each abnormal test result except left ventricular hypertrophy by ECG was independently associated with increased 3-year risk of global CVD (myocardial infarction, stroke, coronary revascularization, incident heart failure, or atrial fibrillation), even after adjustment for traditional CVD risk factors and the other test results. When a simple integer score counting the number of abnormal tests was used, 3-year multivariable-adjusted global CVD risk was increased among participants with integer scores of 1, 2, 3, and 4, by ≈2-, 3-, 4.5- and 8-fold, respectively, when compared with those with a score of 0. Qualitatively similar results were obtained for atherosclerotic CVD (fatal or non-fatal myocardial infarction or stroke). Conclusions A strategy incorporating multiple biomarkers and atherosclerosis imaging improved assessment of 3-year global and atherosclerotic CVD risk compared with a standard approach using traditional risk factors.
- Published
- 2020