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Comparative value of coronary artery calcium and multiple blood biomarkers for prognostication of cardiovascular events.

Publication ,  Journal Article
Rana, JS; Gransar, H; Wong, ND; Shaw, L; Pencina, M; Nasir, K; Rozanski, A; Hayes, SW; Thomson, LE; Friedman, JD; Min, JK; Berman, DS
Published in: Am J Cardiol
May 15, 2012

The value of coronary artery calcium (CAC) scoring versus multiple biomarkers in increasing risk prediction for cardiovascular disease (CVD) remains unknown. The study group consisted of 1,286 asymptomatic participants (mean ± SD 59 ± 8 years old) with no known coronary heart disease. Mean follow-up time was 4.1 ± 0.4 years with the primary outcome of combined CVD (cardiac death, myocardial infarction, stroke, and late target vessel revascularization). CAC was calculated by the method of Agatston. Biomarkers measured were C-reactive protein, interleukin-6, myeloperoxidase, B-type natriuretic peptide, and plasminogen activator-1. During follow-up 35 participants developed CVD events including cardiac deaths (6%), myocardial infarction (23%), strokes (17%), and late revascularizations (54%). In Cox proportional-hazards models adjusted for Framingham Risk Score (FRS), presence of log CAC beyond FRS was associated with increased hazards for CVD events (hazard ratio 1.7, 95% confidence interval [CI] 1.4 to 2.0, p <0.001). Multiple biomarkers score was also associated with increased risk beyond FRS (hazard ratio 2.1, p = 0.02) per 1-U increase in score; however, the c-statistic did not increase significantly (0.75, 95% CI 0.68 to 0.84, p = 0.32). The c-statistic increased when log CAC was incorporated into FRS without or with multiple biomarkers score (c-statistic 0.84, p = 0.003 and p = 0.008 respectively). Addition of CAC to risk factors showed significant reclassification (net reclassification improvement 0.35 (95% CI 0.11 to 0.58, p = 0.007; integrated discrimination index 0.076, p = 0.0001), whereas addition of multiple biomarkers score did not show significant reclassification. In conclusion, in this study of asymptomatic subjects without known CVD, addition of CAC but not biomarkers substantially improved risk reclassification for future CVD events beyond traditional risk factors.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

May 15, 2012

Volume

109

Issue

10

Start / End Page

1449 / 1453

Location

United States

Related Subject Headings

  • United States
  • Tomography, X-Ray Computed
  • Surveys and Questionnaires
  • Risk Factors
  • Risk Assessment
  • Proportional Hazards Models
  • Prognosis
  • Middle Aged
  • Male
  • Incidence
 

Citation

APA
Chicago
ICMJE
MLA
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Rana, J. S., Gransar, H., Wong, N. D., Shaw, L., Pencina, M., Nasir, K., … Berman, D. S. (2012). Comparative value of coronary artery calcium and multiple blood biomarkers for prognostication of cardiovascular events. Am J Cardiol, 109(10), 1449–1453. https://doi.org/10.1016/j.amjcard.2012.01.358
Rana, Jamal S., Heidi Gransar, Nathan D. Wong, Leslee Shaw, Michael Pencina, Khurram Nasir, Alan Rozanski, et al. “Comparative value of coronary artery calcium and multiple blood biomarkers for prognostication of cardiovascular events.Am J Cardiol 109, no. 10 (May 15, 2012): 1449–53. https://doi.org/10.1016/j.amjcard.2012.01.358.
Rana JS, Gransar H, Wong ND, Shaw L, Pencina M, Nasir K, et al. Comparative value of coronary artery calcium and multiple blood biomarkers for prognostication of cardiovascular events. Am J Cardiol. 2012 May 15;109(10):1449–53.
Rana, Jamal S., et al. “Comparative value of coronary artery calcium and multiple blood biomarkers for prognostication of cardiovascular events.Am J Cardiol, vol. 109, no. 10, May 2012, pp. 1449–53. Pubmed, doi:10.1016/j.amjcard.2012.01.358.
Rana JS, Gransar H, Wong ND, Shaw L, Pencina M, Nasir K, Rozanski A, Hayes SW, Thomson LE, Friedman JD, Min JK, Berman DS. Comparative value of coronary artery calcium and multiple blood biomarkers for prognostication of cardiovascular events. Am J Cardiol. 2012 May 15;109(10):1449–1453.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

May 15, 2012

Volume

109

Issue

10

Start / End Page

1449 / 1453

Location

United States

Related Subject Headings

  • United States
  • Tomography, X-Ray Computed
  • Surveys and Questionnaires
  • Risk Factors
  • Risk Assessment
  • Proportional Hazards Models
  • Prognosis
  • Middle Aged
  • Male
  • Incidence