Evaluation of 9 biomarkers for predicting 10-year cardiovascular risk in patients undergoing coronary angiography: Findings from the LUdwigshafen RIsk and Cardiovascular Health (LURIC) study.
Int J Cardiol. 2013 Apr 16;
Authors: Omicron Hartaigh B, Thomas GN, Bosch JA, Hemming K, Pilz S, Loerbroks A, Kleber ME, Grammer TB, Fischer JE, Silbernagel G, Tomaschitz A, März W
BACKGROUND: Conventional factors do not fully explain the distribution of cardiovascular outcomes. Biomarkers are known to participate in well-established pathways associated with cardiovascular disease, and may therefore provide further information over and above conventional risk factors. This study sought to determine whether individual and/or combined assessment of 9 biomarkers improved discrimination, calibration and reclassification of cardiovascular mortality. METHODS: 3267 patients (2283 men), aged 18-95years, at intermediate-to-high-risk of cardiovascular disease were followed in this prospective cohort study. Conventional risk factors and biomarkers were included based on forward and backward Cox proportional stepwise selection models. RESULTS: During 10-years of follow-up, 546 fatal cardiovascular events occurred. Four biomarkers (interleukin-6, neutrophils, von Willebrand factor, and 25-hydroxyvitamin D) were retained during stepwise selection procedures for subsequent analyses. Simultaneous inclusion of these biomarkers significantly improved discrimination as measured by the C-index (0.78, P=0.0001), and integrated discrimination improvement (0.0219, P<0.0001). Collectively, these biomarkers improved net reclassification for cardiovascular death by 10.6% (P<0.0001) when added to the conventional risk model. CONCLUSIONS: In terms of adverse cardiovascular prognosis, a biomarker panel consisting of interleukin-6, neutrophils, von Willebrand factor, and 25-hydroxyvitamin D offered significant incremental value beyond that conveyed by simple conventional risk factors.
PMID: 23601216 [PubMed - as supplied by publisher]