| Title: | Adding traditional and emerging biomarkers for risk assessment in secondary prevention: A prospective cohort study of 20,656 patients with cardiovascular disease |
| Journal: | European Journal of Preventive Cardiology |
| Published: | 30 Oct 2024 |
| DOI: | https://doi.org/10.1093/eurjpc/zwae352 |
Publication 13184
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Abstract
Abstract Background This study aims to explore whether conventional and emerging biomarkers could improve risk discrimination and calibration in secondary prevention of recurrent atherosclerotic cardiovascular disease (ASCVD), based on a model using predictors from SMART2. Methods In a cohort of 20,658 UK Biobank participants with medical history of ASCVD, we analysed any improvement in C indices and net reclassification index (NRI) for future ASCVD events, following addition of LP-a, ApoB, cystatin C, HbA1c, GGT, AST, ALT, and ALP, to a model with predictors used in SMART2 for the outcome of recurrent major cardiovascular event. We also examined any improvement in C indices and NRIs replacing creatinine based estimated glomerular filtration rate (eGFR) with cystatin C based estimates. Calibration plots between different models were also compared. Results Compared with the baseline model (C index=0.663), modest increment in C indices were observed when adding HbA1c (ΔC=0.0064, p<0.001), cystatin C (ΔC=0.0037, p<0.001), GGT (ΔC=0.0023, p<0.001), AST (ΔC= 0.0007, p<0.005) or ALP (ΔC=0.0010, p<0.001) or replacing eGFRCr with eGFRCysC (ΔC=0.0036, p<0.001) or eGFRCr-CysC (ΔC=0.00336, p<0.001). Similarly, the strongest improvements in NRI were observed with the addition of HbA1c (NRI=0.014), or cystatin C (NRI= 0.006) or replacing eGFRCr with eGFRCr-CysC (NRI=0.001) or eGFRCysC (NRI=0.002). There was no evidence that adding biomarkers modify calibration. Conclusions Adding several biomarkers, most notably cystatin C and HbA1c, but not LP-a, in a model using SMART2 predictors modestly improved discrimination. </p>
9 Authors
- Ike Dhiah Rochmawati
- Salil Deo
- Jennifer S Lees
- Patrick B Mark
- Naveed Sattar
- Carlos Celis-Morales
- Jill P Pell
- Paul Welsh
- Frederick K Ho
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