Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2018 Jun 5;71(22):2527-2536.
doi: 10.1016/j.jacc.2018.02.050. Epub 2018 Mar 10.

Short-Term Global Cardiovascular Disease Risk Prediction in Older Adults

Anum Saeed  1 , Vijay Nambi  2 , Wensheng Sun  1 , Salim S Virani  2 , George E Taffet  1 , Anita Deswal  1 , Elizabeth Selvin  3 , Kunihiro Matsushita  3 , Lynne E Wagenknecht  4 , Ron Hoogeveen  1 , Josef Coresh  3 , James A de Lemos  5 , Christie M Ballantyne  6
Affiliations
Observational Study

Short-Term Global Cardiovascular Disease Risk Prediction in Older Adults

Anum Saeed et al. J Am Coll Cardiol. .

Abstract

Background: Current prevention guidelines recommend using the Pooled Cohort Equation (PCE) for 10-year atherosclerotic cardiovascular disease (CVD) risk assessment. However, the PCE has serious limitations in older adults: it excludes heart failure (HF) hospitalization, estimates 10-year risk, which may not be the most relevant time frame, and is not indicated for individuals age >79 years.

Objectives: This study sought to determine whether adding biomarkers to PCE variables improves global CVD (coronary heart disease, stroke, and HF) risk prediction in older adults over a shorter time period.

Methods: Atherosclerosis Risk in Communities study participants without prevalent CVD including HF (n = 4,760; age 75.4 ± 5.1 years) were followed for incident global CVD events. Adding N-terminal pro-B-type natriuretic peptide, high-sensitivity cardiac troponin T, and high-sensitivity C-reactive protein to the PCE and a "lab model" with the biomarkers, age, race, and gender were assessed for prediction improvement. Area under the receiver operating characteristic curve (AUC) and net reclassification index (NRI) were calculated.

Results: Over median follow-up of ∼4 years, incident HF was the leading CVD event (n = 193 vs. 118 coronary heart disease and 81 stroke events). Compared to the PCE, each biomarker improved risk prediction. The largest improvement in risk prediction metrics was with the addition of all 3 biomarkers (ΔAUC 0.103; continuous NRI 0.484). The lab model also performed better than the PCE model (ΔAUC 0.091, continuous NRI 0.355).

Conclusions: Adding biomarkers to the PCE or a simpler "lab model" improves short-term global CVD risk prediction and may be useful to inform short-term preventive strategies in older adults.

Keywords: biomarkers; cardiovascular disease; elderly; heart failure; prevention; risk assessment.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Flow diagram for eligible cohort selection from Atherosclerosis Risk in Communities (ARIC) visit 5
CHD, coronary heart disease; HF, heart failure; CHD, coronary heart disease; HF, heart failure; NT-proBNP: N-terminal pro–B-type natriuretic peptide; hs-CRP, high-sensitivity C-reactive protein; hs-cTnT, high-sensitivity cardiac troponin T.
Figure 2
Figure 2
Receiver operating characteristic curves for models analyzed based on logistic regression results of incident global CVD events.
Central Illustration
Central Illustration. Global CVD events within ~4 years by deciles of risk estimates
Pooled Cohort Equation (PCE) model: age, gender, race, hypertension, antihypertensive medication use, diabetes status, total cholesterol, and high-density lipoprotein cholesterol; complete model: PCE model + hs-cTnT, hs-CRP, and NT-proBNP; lab model: age, gender, race, hs-cTnT, hs-CRP, and NT-proBNP. A: Distribution of global CVD events by deciles of estimated risk; B: Percent of individuals in each estimated risk decile with incident global CVD event.
Central Illustration
Central Illustration. Global CVD events within ~4 years by deciles of risk estimates
Pooled Cohort Equation (PCE) model: age, gender, race, hypertension, antihypertensive medication use, diabetes status, total cholesterol, and high-density lipoprotein cholesterol; complete model: PCE model + hs-cTnT, hs-CRP, and NT-proBNP; lab model: age, gender, race, hs-cTnT, hs-CRP, and NT-proBNP. A: Distribution of global CVD events by deciles of estimated risk; B: Percent of individuals in each estimated risk decile with incident global CVD event.
See this image and copyright information in PMC

Comment in

References

    1. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S1–45. - PubMed
    1. Whelton PK, Carey RM, Aronow WS, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017 doi: 10.1016/j.jacc.2017.11.006. - DOI - PubMed
    1. Werner CA. [Accessed 30 January 2018];The older population. 2010 https://www.census.gov/prod/cen2010/briefs/c2010br-09.pdf.
    1. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017;135:e146–e603. - PMC - PubMed
    1. Whelton SP, Roy P, Astor BC, et al. Elevated high-sensitivity C-reactive protein as a risk marker of the attenuated relationship between serum cholesterol and cardiovascular events at older age: the ARIC Study. Am J Epidemiol. 2013;178:1076–84. - PMC - PubMed

Publication types