TY - JOUR
T1 - Combining biomarkers and imaging for short-term assessment of cardiovascular disease risk in apparently healthy adults
AU - Gore, Maria Odette
AU - Ayers, Colby R.
AU - Khera, Amit
AU - Defilippi, Christopher R.
AU - Wang, Thomas J.
AU - Seliger, Stephen L.
AU - Nambi, Vijay
AU - Selvin, Elizabeth
AU - Berry, Jarett D.
AU - Hundley, W. Gregory
AU - Budoff, Matthew
AU - Greenland, Philip
AU - Drazner, Mark H.
AU - Ballantyne, Christie M.
AU - Levine, Benjamin D.
AU - de Lemos, James A.
N1 - Publisher Copyright:
© 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2020/8/4
Y1 - 2020/8/4
N2 - 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.
AB - 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.
KW - Carotid intima-media thickness
KW - Coronary artery calcium
KW - High-sensitivity C-reactive protein
KW - High-sensitivity cardiac troponin T
KW - N-terminal pro B-type natriuretic peptide
KW - Plaque
UR - http://www.scopus.com/inward/record.url?scp=85089163767&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85089163767&partnerID=8YFLogxK
U2 - 10.1161/JAHA.119.015410
DO - 10.1161/JAHA.119.015410
M3 - Article
C2 - 32698652
AN - SCOPUS:85089163767
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 15
M1 - e015410
ER -