Traditional Risk Factors Versus Biomarkers for Prediction of Secondary Events in Patients With Stable Coronary Heart Disease: From the Heart and Soul Study

被引:45
作者
Beatty, Alexis L. [1 ,3 ,4 ]
Ku, Ivy A. [1 ,5 ,6 ]
Bibbins-Domingo, Kirsten [1 ,2 ,5 ]
Christenson, Robert H. [7 ]
DeFilippi, Christopher R. [8 ]
Ganz, Peter [1 ,5 ]
Ix, Joachim H. [9 ,10 ,11 ]
Lloyd-Jones, Donald [12 ,13 ,14 ]
Omland, Torbjorn [15 ,16 ]
Sabatine, Marc S. [17 ,18 ]
Schiller, Nelson B. [1 ]
Shlipak, Michael G. [1 ,2 ,19 ]
Skali, Hicham [18 ]
Takeuchi, Madoka [6 ]
Vittinghoff, Eric [2 ]
Whooley, Mary A. [1 ,2 ,19 ]
机构
[1] Univ Calif San Francisco, Dept Med, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA
[3] VA Puget Sound Hlth Care Syst, Cardiol Sect, Seattle, WA 98108 USA
[4] Univ Washington, Dept Med, Seattle, WA 98195 USA
[5] San Francisco Gen Hosp, San Francisco, CA 94110 USA
[6] Kaiser Permanente Med Ctr, Dept Cardiol, San Francisco, CA USA
[7] Univ Maryland, Dept Pathol, Sch Med, Baltimore, MD 21201 USA
[8] Univ Maryland, Dept Med, Sch Med, Baltimore, MD 21201 USA
[9] Vet Affairs San Diego Healthcare Syst, Nephrol Sect, San Diego, CA USA
[10] Univ Calif San Diego, Div Nephrol & Hypertens, Dept Med, San Diego, CA 92103 USA
[11] Univ Calif San Diego, Div Prevent Med, Dept Family & Prevent Med, San Diego, CA 92103 USA
[12] Northwestern Univ, Dept Prevent Med, Feinberg Sch Med, Chicago, IL 60611 USA
[13] Northwestern Univ, Bluhm Cardiovasc Inst, Feinberg Sch Med, Chicago, IL 60611 USA
[14] Northwestern Univ, Dept Med, Feinberg Sch Med, Chicago, IL 60611 USA
[15] Akershus Univ Hosp, Div Med, Lorenskog, Norway
[16] Univ Oslo, Lorenskog, Norway
[17] Harvard Univ, Brigham & Womens Hosp, TIMI Study Grp, Cardiovasc Div,Dept Med,Med Sch, Boston, MA 02115 USA
[18] Harvard Univ, Brigham & Womens Hosp, Div Cardiovasc, Sch Med, Boston, MA 02115 USA
[19] Vet Affairs Med Ctr, Gen Internal Med Sect, San Francisco, CA 94121 USA
来源
JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2015年 / 4卷 / 07期
基金
美国国家卫生研究院;
关键词
coronary disease; epidemiology; prevention; risk prediction; CONVERTING-ENZYME-INHIBITION; GLOMERULAR-FILTRATION-RATE; CHRONIC KIDNEY-DISEASE; CARDIOVASCULAR RISK; NATRIURETIC-PEPTIDE; ARTERY-DISEASE; MYOCARDIAL-INFARCTION; MULTIPLE BIOMARKERS; VALIDATION; PREVENTION;
D O I
10.1161/JAHA.114.001646
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Patients with stable coronary heart disease (CHD) have widely varying prognoses and treatment options. Validated models for risk stratification of patients with CHD are needed. We sought to evaluate traditional and novel risk factors as predictors of secondary cardiovascular (CV) events, and to develop a prediction model that could be used to risk stratify patients with stable CHD. Methods and Results-We used independent derivation (912 participants in the Heart and Soul Study) and validation (2876 participants in the PEACE trial) cohorts of patients with stable CHD to develop a risk prediction model using Cox proportional hazards models. The outcome was CV events, defined as myocardial infarction, stroke, or CV death. The annual rate of CV events was 3.4% in the derivation cohort and 2.2% in the validation cohort. With the exception of smoking, traditional risk factors (including age, sex, body mass index, hypertension, dyslipidemia, and diabetes) did not emerge as the top predictors of secondary CV events. The top 4 predictors of secondary events were the following: N-terminal pro-type brain natriuretic peptide, high-sensitivity cardiac troponin T, urinary albumin: creatinine ratio, and current smoking. The 5-year C-index for this 4-predictor model was 0.73 in the derivation cohort and 0.65 in the validation cohort. As compared with variables in the Framingham secondary events model, the Heart and Soul risk model resulted in net reclassification improvement of 0.47 (95% CI 0.25 to 0.73) in the derivation cohort and 0.18 (95% CI 0.01 to 0.40) in the validation cohort. Conclusions-Novel risk factors are superior to traditional risk factors for predicting 5-year risk of secondary events in patients with stable CHD.
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页数:9
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