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Prognostic value of...
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Neumann, Johannes TobiasDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
(author)
Prognostic value of cardiovascular biomarkers in the population
- Article/chapterEnglish2024
Publisher, publication year, extent ...
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American Medical Association (AMA),2024
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printrdacarrier
Numbers
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LIBRIS-ID:oai:DiVA.org:umu-224931
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https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-224931URI
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https://doi.org/10.1001/jama.2024.5596DOI
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
Notes
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Importance: Identification of individuals at high risk for atherosclerotic cardiovascular disease within the population is important to inform primary prevention strategies.Objective: To evaluate the prognostic value of routinely available cardiovascular biomarkers when added to established risk factors.Design, Setting, and Participants: Individual-level analysis including data on cardiovascular biomarkers from 28 general population-based cohorts from 12 countries and 4 continents with assessments by participant age. The median follow-up was 11.8 years.Exposure: Measurement of high-sensitivity cardiac troponin I, high-sensitivity cardiac troponin T, N-terminal pro-B-type natriuretic peptide, B-type natriuretic peptide, or high-sensitivity C-reactive protein.Main Outcomes and Measures: The primary outcome was incident atherosclerotic cardiovascular disease, which included all fatal and nonfatal events. The secondary outcomes were all-cause mortality, heart failure, ischemic stroke, and myocardial infarction. Subdistribution hazard ratios (HRs) for the association of biomarkers and outcomes were calculated after adjustment for established risk factors. The additional predictive value of the biomarkers was assessed using the C statistic and reclassification analyses.Results: The analyses included 164054 individuals (median age, 53.1 years [IQR, 42.7-62.9 years] and 52.4% were women). There were 17211 incident atherosclerotic cardiovascular disease events. All biomarkers were significantly associated with incident atherosclerotic cardiovascular disease (subdistribution HR per 1-SD change, 1.13 [95% CI, 1.11-1.16] for high-sensitivity cardiac troponin I; 1.18 [95% CI, 1.12-1.23] for high-sensitivity cardiac troponin T; 1.21 [95% CI, 1.18-1.24] for N-terminal pro-B-type natriuretic peptide; 1.14 [95% CI, 1.08-1.22] for B-type natriuretic peptide; and 1.14 [95% CI, 1.12-1.16] for high-sensitivity C-reactive protein) and all secondary outcomes. The addition of each single biomarker to a model that included established risk factors improved the C statistic. For 10-year incident atherosclerotic cardiovascular disease in younger people (aged <65 years), the combination of high-sensitivity cardiac troponin I, N-terminal pro-B-type natriuretic peptide, and high-sensitivity C-reactive protein resulted in a C statistic improvement from 0.812 (95% CI, 0.8021-0.8208) to 0.8194 (95% CI, 0.8089-0.8277). The combination of these biomarkers also improved reclassification compared with the conventional model. Improvements in risk prediction were most pronounced for the secondary outcomes of heart failure and all-cause mortality. The incremental value of biomarkers was greater in people aged 65 years or older vs younger people.Conclusions and Relevance: Cardiovascular biomarkers were strongly associated with fatal and nonfatal cardiovascular events and mortality. The addition of biomarkers to established risk factors led to only a small improvement in risk prediction metrics for atherosclerotic cardiovascular disease, but was more favorable for heart failure and mortality..
Subject headings and genre
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Twerenbold, RaphaelDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
(author)
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Weimann, JessicaDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
(author)
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Ballantyne, Christie M.Center for Cardiometabolic Disease Prevention, Department of Medicine, College of Medicine, Baylor University, TX, Houston, United States
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Benjamin, Emelia J.Department of Medicine, Boston Medical Center, Chobanian and Avedisian School of Medicine, Boston University, MA, Boston, United States; Department of Epidemiology, School of Public Health, Boston University, MA, Boston, United States
(author)
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Costanzo, SimonaDepartment of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
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De Lemos, James A.Department of Internal Medicine, UT Southwestern Medical Center, TX, Dallas, United States
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Defilippi, Christopher R.Inova Heart and Vascular Institute, VA, Falls Church, United States
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Di Castelnuovo, AugustoMediterranea Cardiocentro, Naples, Italy
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Donfrancesco, ChiaraDepartment of Cardiovascular Endocrine-Metabolic Diseases, and Aging, National Institute of Health, Rome, Italy
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Dörr, MarcusDepartment of Internal Medicine B, University Greifswald, Greifswald, Germany; German Center for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany
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Eggers, Kai M.Departments of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
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Engström, GunnarDepartment of Clinical Sciences, Lund University, Malmö, Sweden
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Felix, Stephan B.Department of Internal Medicine B, University Greifswald, Greifswald, Germany; German Center for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany
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Ferrario, Marco M.Research Centre in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Gansevoort, Ron T.Department of Nephrology, University Medical Center Groningen, Groningen, Netherlands
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Giampaoli, SimonaIstituto Superiore di Sanità, Rome, Italy
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Giedraitis, VilmantasDepartment of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
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Hedberg, PärDepartment of Clinical Physiology, Centre for Clinical Research, Västmanland County Hospital, Uppsala University, Västerås, Sweden
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Iacoviello, LiciaDepartment of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy; Department of Medicine and Surgery, Libera Università Mediterranea, Casamassima, Italy
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Jørgensen, TorbenDepartment of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Centre for Clinical Research and Prevention, BFH Hospital, Copenhagen, Denmark
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Kee, FrankUKCRC, Centre of Excellence for Public Health, Queens University of Belfast, Belfast, United Kingdom
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Koenig, WolfgangGerman Heart Center, Technical University of Munich, Munich, Germany; Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany; German Center for Cardiovascular Disease Research, Partner Site Munich Heart Alliance, Munich, Germany
(author)
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Kuulasmaa, KariFinnish Institute for Health and Welfare, Helsinki, Finland
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Lewis, Joshua R.Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia; Medical School, University of Western Australia, Perth, Australia; Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
(author)
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Lorenz, ThiessDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
(author)
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Lyngbakken, Magnus N.Division of Medicine, Department of Cardiology, Akershus University Hospital, Lorenskog, Norway; K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
(author)
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Magnussen, ChristinaDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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Melander, OlleDepartments of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
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Nauck, MatthiasGerman Center for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany; Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
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Niiranen, Teemu J.Finnish Institute for Health and Welfare, Helsinki, Finland; Division of Medicine, Turku University Hospital, Turku, Finland; Department of Internal Medicine, University of Turku, Turku, Finland
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Nilsson, Peter M.Departments of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
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Olsen, Michael H.Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark; Department of Regional Health, University of Southern Denmark, Odense, Denmark
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Omland, TorbjornDivision of Medicine, Department of Cardiology, Akershus University Hospital, Lorenskog, Norway; K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
(author)
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Oskarsson, ViktorUmeå universitet,Avdelningen för medicin(Swepub:umu)vios0009
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Palmieri, LuigiDepartment of Cardiovascular Endocrine-Metabolic Diseases, and Aging, National Institute of Health, Rome, Italy
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Peters, AnetteGerman Center for Cardiovascular Disease Research, Partner Site Munich Heart Alliance, Munich, Germany; Institute of Epidemiology Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität, Munich, Germany
(author)
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Prince, Richard L.Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia; Medical School, University of Western Australia, Perth, Australia
(author)
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Qaderi, VazhmaDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
(author)
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Vasan, Ramachandran S.Department of Medicine, Boston Medical Center, Chobanian and Avedisian School of Medicine, Boston University, MA, Boston, United States; University of Texas, School of Public Health, The University of Texas, Health Science Center, San Antonio, United States
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Salomaa, VeikkoFinnish Institute for Health and Welfare, Helsinki, Finland
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Sans, SusanaCatalan Department of Health, Barcelona, Spain
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Smith, J. GustavWallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
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Söderberg, StefanUmeå universitet,Avdelningen för medicin(Swepub:umu)stso0001
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Thorand, BarbaraInstitute of Epidemiology Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität, Munich, Germany
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Tonkin, Andrew M.Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Tunstall-Pedoe, HughCardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, United Kingdom
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Veronesi, GiovanniResearch Centre in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Watanabe, TetsuDepartment of Cardiology Pulmonology, and Nephrology, School of Medicine, Yamagata University, Yamagata, Japan
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Watanabe, MasafumiDepartment of Cardiology Pulmonology, and Nephrology, School of Medicine, Yamagata University, Yamagata, Japan
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Zeiher, Andreas M.Institute for Cardiovascular Regeneration, Goethe University, Frankfurt, Germany; German Center for Cardiovascular Disease Research, Partner Site Rhine-Main, Mainz, Germany
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Zeller, TanjaDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
(author)
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Blankenberg, StefanDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
(author)
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Ojeda, FranciscoDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
(author)
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Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, AustraliaDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
(creator_code:org_t)
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In:Journal of the American Medical Association (JAMA): American Medical Association (AMA)331:22, s. 1898-19090098-74841538-3598
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Kuulasmaa, Kari
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Melander, Olle
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Nauck, Matthias
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Niiranen, Teemu ...
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Prince, Richard ...
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Qaderi, Vazhma
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Vasan, Ramachand ...
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Salomaa, Veikko
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Sans, Susana
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Smith, J. Gustav
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Thorand, Barbara
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Tonkin, Andrew M ...
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Tunstall-Pedoe, ...
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Veronesi, Giovan ...
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Watanabe, Tetsu
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