Enhancing Risk Prediction for Atherosclerotic Cardiovascular Disease (ASCVD)

Researchers in a recent study have sought to enhance risk prediction for atherosclerotic cardiovascular disease (ASCVD) by evaluating the prognostic value of various cardiovascular biomarkers in addition to established risk factors. Identifying individuals at high risk for ASCVD is crucial for informing primary prevention strategies. However, their impact is more significant for heart failure and mortality outcomes, particularly in older adults. This study was published in JAMA by Neumann JT and colleagues.

The study included individuals with a median age of 53.1 years, of whom 52.4% were women, with a median follow-up of 11.8 years. Incidence of ASCVD events totaled 17,211 cases during the follow-up period. Each biomarker showed a significant association with ASCVD and secondary outcomes. Addition of biomarkers to established risk factor models led to a small improvement in risk prediction metrics for ASCVD but had a more pronounced impact on heart failure and mortality outcomes, particularly in individuals aged 65 years or older.

Key Findings

• The study analyzed data from 164,054 individuals across 28 population-based cohorts from 12 countries and 4 continents.
• All biomarkers, including high-sensitivity cardiac troponin I, high-sensitivity cardiac troponin T, N-terminal pro-B-type natriuretic peptide, B-type natriuretic peptide, and high-sensitivity C-reactive protein, were significantly associated with incident ASCVD events and secondary outcomes such as all-cause mortality, heart failure, ischemic stroke, and myocardial infarction.
• Addition of each biomarker to established risk factor models improved the C statistic, with the combination of high-sensitivity cardiac troponin I, N-terminal pro-B-type natriuretic peptide, and high-sensitivity C-reactive protein showing the most substantial improvement in risk prediction for ASCVD, particularly in younger adults aged <65 years.
• However, the incremental value of biomarkers in improving risk prediction metrics for ASCVD was modest, although more favorable for heart failure and mortality outcomes.

While cardiovascular biomarkers were strongly associated with fatal and nonfatal cardiovascular events and mortality, their addition to established risk factors only marginally improved risk prediction for ASCVD. However, the incremental value of biomarkers was more pronounced for heart failure and mortality outcomes. These findings suggest that while biomarkers may offer some additional predictive value, their impact on overall risk prediction for ASCVD is limited, particularly in younger adults.

Reference

Neumann JT, Twerenbold R, Weimann J, et al. Prognostic Value of Cardiovascular Biomarkers in the Population. JAMA. Published online May 13, 2024. doi:10.1001/jama.2024.5596