PURPOSE: The study purpose was to evaluate the ability of 6 biomarkers to improve the prediction of cardiovascular events among persons with established coronary artery disease. BACKGROUND: Cardiovascular risk algorithms are designed to predict the initial onset of coronary artery disease but are less effective in persons with preexisting coronary artery disease. METHODS: We examined the association of N-terminal prohormone brain natriuretic peptide (Nt-proBNP), cystatin C, albuminuria, C-reactive protein (CRP), interleukin-6, and fibrinogen with cardiovascular events in 979 Heart and Soul Study participants with coronary artery disease after adjusting for demographic, lifestyle, and behavior variables; cardiovascular risk factors; cardiovascular disease severity; medication use; and left ventricular ejection fraction. The outcome was a composite of stroke, myocardial infarction, and coronary heart disease death during an average of 3.5 years of follow-up. RESULTS: During follow-up, 142 participants (15%) developed cardiovascular events. The highest quartiles (vs lower 3 quartiles) of 5 biomarkers were individually associated with cardiovascular risk after multivariate analysis: Nt-proBNP hazard ratio (HR)=2.13 (95% confidence interval [CI], 1.43-3.18); cystatin C HR=1.72 (95% CI, 1.10-2.70); albuminuria HR=1.71 (95% CI, 1.15-2.54); CRP HR=2.00 (95% CI, 1.40-2.85); and interleukin-6 HR=1.76 (95% CI, 1.22-2.53). When all biomarkers were included in the multivariable analysis, only Nt-proBNP, albuminuria, and CRP remained significant predictors of events: HR=1.88 (95% CI, 1.23-2.85), HR=1.63 (95% CI, 1.09-2.43), and HR=1.82 (95% CI, 1.24-2.67), respectively. The area under the receiver operator curve for clinical predictors alone was 0.73 (95% CI, 0.68-0.78); adding Nt-proBNP, albuminuria, and CRP significantly increased the area under the receiver operator curve to 0.77 (95% CI, 0.73-0.82, P<.005). CONCLUSION: Among persons with prevalent coronary artery disease, biomarkers reflecting hemodynamic stress, kidney damage, and inflammation added significant risk discrimination for cardiovascular events.
PURPOSE: The study purpose was to evaluate the ability of 6 biomarkers to improve the prediction of cardiovascular events among persons with established coronary artery disease. BACKGROUND: Cardiovascular risk algorithms are designed to predict the initial onset of coronary artery disease but are less effective in persons with preexisting coronary artery disease. METHODS: We examined the association of N-terminal prohormone brain natriuretic peptide (Nt-proBNP), cystatin C, albuminuria, C-reactive protein (CRP), interleukin-6, and fibrinogen with cardiovascular events in 979 Heart and Soul Study participants with coronary artery disease after adjusting for demographic, lifestyle, and behavior variables; cardiovascular risk factors; cardiovascular disease severity; medication use; and left ventricular ejection fraction. The outcome was a composite of stroke, myocardial infarction, and coronary heart disease death during an average of 3.5 years of follow-up. RESULTS: During follow-up, 142 participants (15%) developed cardiovascular events. The highest quartiles (vs lower 3 quartiles) of 5 biomarkers were individually associated with cardiovascular risk after multivariate analysis: Nt-proBNP hazard ratio (HR)=2.13 (95% confidence interval [CI], 1.43-3.18); cystatin C HR=1.72 (95% CI, 1.10-2.70); albuminuria HR=1.71 (95% CI, 1.15-2.54); CRP HR=2.00 (95% CI, 1.40-2.85); and interleukin-6 HR=1.76 (95% CI, 1.22-2.53). When all biomarkers were included in the multivariable analysis, only Nt-proBNP, albuminuria, and CRP remained significant predictors of events: HR=1.88 (95% CI, 1.23-2.85), HR=1.63 (95% CI, 1.09-2.43), and HR=1.82 (95% CI, 1.24-2.67), respectively. The area under the receiver operator curve for clinical predictors alone was 0.73 (95% CI, 0.68-0.78); adding Nt-proBNP, albuminuria, and CRP significantly increased the area under the receiver operator curve to 0.77 (95% CI, 0.73-0.82, P<.005). CONCLUSION: Among persons with prevalent coronary artery disease, biomarkers reflecting hemodynamic stress, kidney damage, and inflammation added significant risk discrimination for cardiovascular events.
Authors: Stefan Blankenberg; Matthew J McQueen; Marek Smieja; Janice Pogue; Cynthia Balion; Eva Lonn; Hans J Rupprecht; Christoph Bickel; Laurence Tiret; Francois Cambien; Hertzel Gerstein; Thomas Münzel; Salim Yusuf Journal: Circulation Date: 2006-07-10 Impact factor: 29.690
Authors: Kirsten Bibbins-Domingo; Reena Gupta; Beeya Na; Alan H B Wu; Nelson B Schiller; Mary A Whooley Journal: JAMA Date: 2007-01-10 Impact factor: 56.272
Authors: Joachim H Ix; Glenn M Chertow; Michael G Shlipak; Vincent M Brandenburg; Markus Ketteler; Mary A Whooley Journal: Nephrol Dial Transplant Date: 2006-04-27 Impact factor: 5.992
Authors: B G Angeja; M G Shlipak; A S Go; S C Johnston; P D Frederick; J G Canto; H V Barron; D Grady Journal: J Am Coll Cardiol Date: 2001-11-01 Impact factor: 24.094
Authors: Marc S Sabatine; David A Morrow; James A de Lemos; C Michael Gibson; Sabina A Murphy; Nader Rifai; Carolyn McCabe; Elliott M Antman; Christopher P Cannon; Eugene Braunwald Journal: Circulation Date: 2002-04-16 Impact factor: 29.690
Authors: Mary S Beattie; Michael G Shlipak; Haiying Liu; Warren S Browner; Nelson B Schiller; Mary A Whooley Journal: Circulation Date: 2003-01-21 Impact factor: 29.690
Authors: Bernice Ruo; John S Rumsfeld; Mark A Hlatky; Haiying Liu; Warren S Browner; Mary A Whooley Journal: JAMA Date: 2003-07-09 Impact factor: 56.272
Authors: Eric Vittinghoff; Michael G Shlipak; Paul D Varosy; Curt D Furberg; Christine C Ireland; Steven S Khan; Roger Blumenthal; Elizabeth Barrett-Connor; Stephen Hulley Journal: Ann Intern Med Date: 2003-01-21 Impact factor: 25.391
Authors: R Lertnawapan; A Bian; Y H Rho; P Raggi; A Oeser; J F Solus; T Gebretsadik; A Shintani; C M Stein Journal: Lupus Date: 2011-11-09 Impact factor: 2.911
Authors: Naja Dam Mygind; Marina J Harutyunyan; Anders Bruun Mathiasen; Rasmus S Ripa; Jens Jacob Thune; Jens Peter Gøtze; Julia S Johansen; Jens Kastrup Journal: Inflamm Res Date: 2010-10-23 Impact factor: 4.575
Authors: Paul M McKie; Alessandro Cataliotti; Brian D Lahr; Fernando L Martin; Margaret M Redfield; Kent R Bailey; Richard J Rodeheffer; John C Burnett Journal: J Am Coll Cardiol Date: 2010-05-11 Impact factor: 24.094
Authors: Amanda Mocroft; Christina Wyatt; Lynda Szczech; Jacquie Neuhaus; Wafaa El-Sadr; Russell Tracy; Lewis Kuller; Michael Shlipak; Brian Angus; Harting Klinker; Michael Ross Journal: AIDS Date: 2009-01-02 Impact factor: 4.177