Multimarker Prediction of Coronary Heart Disease Risk The Women's Health Initiative

被引：94

作者：

Kim, Hyeon Chang ^{[2
]}

Greenland, Philip ^{[1
]}

Rossouw, Jacques E. ^{[3
]}

Manson, JoAnn E. ^{[4
]}

Cochrane, Barbara B. ^{[5
]}

Lasser, Norman L. ^{[6
]}

Limacher, Marian C. ^{[7
]}

Lloyd-Jones, Donald M.

Margolis, Karen L. ^{[8
]}

Robinson, Jennifer G. ^{[9
]}

机构：

[1] Northwestern Univ, Feinberg Sch Med, Dept Prevent Med, Chicago, IL 60611 USA

[2] Yonsei Univ, Dept Prevent Med, Seoul 120749, South Korea

[3] NHLBI, Bethesda, MD 20892 USA

[4] Harvard Univ, Brigham & Womens Hosp, Sch Med, Boston, MA 02115 USA

[5] Univ Washington, Family & Child Nursing Dept, Seattle, WA 98195 USA

[6] Univ Med & Dent New Jersey, New Jersey Med Sch, Prevent Cardiol Program, Newark, NJ 07103 USA

[7] Univ Florida, Div Cardiovasc Med, Gainesville, FL USA

[8] Hlth Partners Res Fdn, Minneapolis, MN USA

[9] Univ Iowa, Dept Epidemiol & Med, Iowa City, IA USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2010年 / 55卷 / 19期

基金：

美国国家卫生研究院;

关键词：

coronary heart disease; prediction; biomarker; C-REACTIVE PROTEIN; INCIDENT CARDIOVASCULAR EVENTS; RANDOMIZED CONTROLLED-TRIAL; ESTROGEN PLUS PROGESTIN; FIBRIN D-DIMER; ATHEROSCLEROSIS RISK; POSTMENOPAUSAL WOMEN; LEUKOCYTE COUNT; MYOCARDIAL-INFARCTION; INFLAMMATORY MARKERS;

D O I：

10.1016/j.jacc.2009.12.047

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The aim of this study was to investigate whether multiple biomarkers contribute to improved coronary heart disease (CHD) risk prediction in post-menopausal women compared with assessment using traditional risk factors (TRFs) only. Background The utility of newer biomarkers remains uncertain when added to predictive models using only TRFs for CHD risk assessment. Methods The Women's Health Initiative Hormone Trials enrolled 27,347 post-menopausal women ages 50 to 79 years. Associations of TRFs and 18 biomarkers were assessed in a nested case-control study including 321 patients with CHD and 743 controls. Four prediction equations for 5-year CHD risk were compared: 2 Framingham risk score covariate models; a TRF model including statin treatment, hormone treatment, and cardiovascular disease history as well as the Framingham risk score covariates; and an additional biomarker model that additionally included the 5 significantly associated markers of the 18 tested (interleukin-6, D-dimer, coagulation factor VIII, von Willebrand factor, and homocysteine). Results The TRF model showed an improved C-statistic (0.729 vs. 0.699, p = 0.001) and net reclassification improvement (6.42%) compared with the Framingham risk score model. The additional biomarker model showed additional improvement in the C-statistic (0.751 vs. 0.729, p = 0.001) and net reclassification improvement (6.45%) compared with the TRF model. Predicted CHD risks on a continuous scale showed high agreement between the TRF and additional biomarker models (Spearman's coefficient = 0.918). Among the 18 biomarkers measured, C-reactive protein level did not significantly improve CHD prediction either alone or in combination with other biomarkers. Conclusions Moderate improvement in CHD risk prediction was found when an 18-biomarker panel was added to predictive models using TRFs in post-menopausal women. (J Am Coll Cardiol 2010;55:2080-91) (C) 2010 by the American College of Cardiology Foundation

引用

页码：2080 / 2091

页数：12

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