Circulating cardiac biomarkers improve risk stratification for incident cardiovascular disease in community dwelling populations

• Published in: EBioMedicine Vol. 82; p. 104170
• Main Authors: Wu, Zhenqiang, Pilbrow, Anna P., Liew, Oi Wah, Chong, Jenny P.C., Sluyter, John, Lewis, Lynley K., Lasse, Moritz, Frampton, Chris M., Jackson, Rod, Poppe, Katrina, Camargo, Carlos Arturo, Cameron, Vicky A., Scragg, Robert, Richards, A. Mark
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.08.2022; Elsevier
• Subjects: Cardiac biomarkers; Community populations; Epidemiology; Incident cardiovascular disease; Risk stratification; Incident cardiovascular disease; Cardiac biomarkers; Epidemiology; Community populations; Risk stratification
• ISSN: 2352-3964; 2352-3964
• DOI: 10.1016/j.ebiom.2022.104170

Plasma cardiac markers may assist in prediction of incident cardiovascular disease. The incremental value of cardiac Troponins (T and I) and NT-proBNP added to risk factors in the PREDICT score for incident cardiovascular disease (CVD) in primary care, was assessed in 4102 asymptomatic participants in a randomised controlled trial of Vitamin D (ViDA). Findings were corroborated in 2528 participants in a separate community-based observational registry of CVD-free volunteers (HVOLS). Hazard ratios for first cardiovascular events adjusted for PREDICT risk factors, comparing fifth to first quintiles of marker plasma concentrations, were 2.57 (95% CI 1.47-4.49); 3.01 (1.66-5.48) and 3.38 (2.04-5.60) for hs-cTnI, hs-cTnT and NT-proBNP respectively. The C statistic for discrimination of the primary endpoint increased from 0.755 to 0.771 (+0.016, p = 0.01). Cardiac marker data correctly reclassified risk upwards in 6.7% of patients and downwards in 3.3%. These findings were corroborated by results from HVOLS. Increments in plasma cardiac biomarkers robustly and reproducibly predicted increased hazard of incident CVD, independent of established risk factors, in two community-dwelling populations. Cardiac markers may augment risk assessment for onset of CVD in primary care. ViDA was funded by the Health Research Council of New Zealand (grant 10/400) and the Accident Compensation Corporation. HVOLS was funded by the Health Research Council of NZ Programme Grants (grants 02/152 and 08/070) and by grants from the Heart Foundation of NZ and the Christchurch Heart Institute Trust. Roche Diagnostics provided in-kind support for NT-proBNP and hs-cTnT assays and Abbott Laboratories for hs-cTnI assays.