Combining Biomarkers and Imaging for Short‐Term Assessment of Cardiovascular Disease Risk in Apparently Healthy Adults

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Elizabeth Selvin¹  Vijay Nambi²  Christie M. Ballantyne²  Maria Odette Gore³  Stephen L. Seliger⁴  Jarett D. Berry⁵  Benjamin D. Levine⁵  Amit Khera⁵  Thomas J. Wang⁵  Colby R. Ayers⁵  Mark H. Drazner⁵  James A. de Lemos⁵  Philip Greenland⁶  W. Gregory Hundley⁷  Christopher R. deFilippi⁸  Matthew Budoff⁹ 

[1] Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD;Department of Medicine Baylor College of Medicine Houston TX;Department of Medicine University of Colorado Anschutz Medical Campus Aurora CO;Department of Medicine University of Maryland School of Medicine Baltimore MD;Department of Medicine University of Texas Southwestern Medical Center Dallas TX;Department of Preventive Medicine Feinberg School of Medicine, Northwestern University Chicago IL;Departments of Medicine and Radiological Sciences Wake Forest Health Sciences Winston‐Salem NC;Inova Heart and Vascular Institute Fall Church VA;Los Angeles Biomedical Research Institute Los Angeles CA;

关键词: 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;   

DOI  :  10.1161/JAHA.119.015410

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown