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
Randomized Controlled Trial
. 2022 Aug:82:104170.
doi: 10.1016/j.ebiom.2022.104170. Epub 2022 Jul 15.

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

Zhenqiang Wu  1 , Anna P Pilbrow  2 , Oi Wah Liew  3 , Jenny P C Chong  3 , John Sluyter  1 , Lynley K Lewis  2 , Moritz Lasse  2 , Chris M Frampton  2 , Rod Jackson  1 , Katrina Poppe  1 , Carlos Arturo Camargo Jr  4 , Vicky A Cameron  2 , Robert Scragg  1 , A Mark Richards  5
Affiliations
Randomized Controlled Trial

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

Zhenqiang Wu et al. EBioMedicine. 2022 Aug.

Abstract

Background: Plasma cardiac markers may assist in prediction of incident cardiovascular disease.

Methods: 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).

Findings: 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.

Interpretation: 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.

Funding: 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.

Keywords: Cardiac biomarkers; Community populations; Epidemiology; Incident cardiovascular disease; Risk stratification.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests Zhenqiang Wu: 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 hsTnT assays and Abbott Laboratories for hsTnI assays. Anna P Pilbrow: Nil to disclose. Oi Wah Liew: Nil to disclose. Jenny P C Chong: Nil to disclose. John Sluyter: Support from Christchurch Heart Institute; travel costs for traveling to Christchurch to discuss ViDA study (give presentation) and methodology; costs for working with plasma aliquots from ViDA study. Data preparation, extraction of samples from freezer, data checking, arranging samples for couriering. Lynley K Lewis: Nil to disclose. Moritz Lasse: Nil to disclose. Chris M Frampton: Nil to disclose. Rod Jackson: Nil to disclose. Katrina Poppe: New Zealand Heart Foundation Senior fellowship to support salary; domestic travel to national meetings. Carlos Arturo Camargo Jr: Nil to disclose. Vicky Cameron A.: Nil to disclose. Robert Scragg: Health Research Council of New Zealand Application 10/400. Main government funder of health research in NZ. Accident Compensation Corporation. Main government insurer for health costs arising from injury. A Mark Richards: Roche Diagnostics In kind support for assays. Abbott Labs In kind support for assays. Roche Diagnostics advisory board fees.

Figures

Figure 1
Figure 1
Plots of predicted versus observed event rates in successive deciles of risk in (a) ViDA and (b) HVOLS for cohort-specific risk equations derived from multivariable analyses of ViDA and HVOLS data incorporating the PREDICT risk factors.
Figure 2
Figure 2
Kaplan Meier cumulative curves for first cardiovascular events among ViDA participants with baseline plasma concentrations of (a) hs Troponin T (b) hs Troponin I and (c) NT-proBNP above compared with below clinically applied thresholds.
See this image and copyright information in PMC

References

    1. Goff DC, Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 suppl 2):S49–S73. - PubMed
    1. Damen JA, Hooft L, Schuit E, et al. Prediction models for cardiovascular disease risk in the general population: systematic review. BMJ. 2016;353:i2416. - PMC - PubMed
    1. Pylypchuk R, Wells S, Kerr A, et al. Cardiovascular disease risk prediction equations in 400 000 primary care patients in New Zealand: a derivation and validation study. Lancet. 2018;391:1897–1907. - PubMed
    1. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129–2200. - PubMed
    1. Yancy CW, Jessup M, Bozkurt B, et al. 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart failure society of America. J Am Coll Cardiol. 2016;68(13):1476–1488. - PubMed

Publication types