1. Traditional Risk Factors Versus Biomarkers for Prediction of Secondary Events in Patients With Stable Coronary Heart Disease: From the Heart and Soul Study.
- Author
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Beatty AL, Ku IA, Bibbins-Domingo K, Christenson RH, DeFilippi CR, Ganz P, Ix JH, Lloyd-Jones D, Omland T, Sabatine MS, Schiller NB, Shlipak MG, Skali H, Takeuchi M, Vittinghoff E, and Whooley MA
- Subjects
- Aged, Aged, 80 and over, Albuminuria diagnosis, Albuminuria mortality, Albuminuria urine, Biomarkers blood, Biomarkers urine, Comorbidity, Coronary Disease diagnosis, Coronary Disease metabolism, Coronary Disease mortality, Disease Progression, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Myocardial Infarction diagnosis, Myocardial Infarction metabolism, Myocardial Infarction mortality, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Prospective Studies, Reproducibility of Results, Risk Assessment, Risk Factors, Smoking adverse effects, Smoking mortality, Stroke diagnosis, Stroke metabolism, Stroke mortality, Time Factors, United States epidemiology, Albuminuria epidemiology, Coronary Disease epidemiology, Creatinine urine, Decision Support Techniques, Myocardial Infarction epidemiology, Natriuretic Peptide, Brain blood, Peptide Fragments blood, Smoking epidemiology, Stroke epidemiology, Troponin T blood
- Abstract
Background: Patients with stable coronary heart disease (CHD) have widely varying prognoses and treatment options. Validated models for risk stratification of patients with CHD are needed. We sought to evaluate traditional and novel risk factors as predictors of secondary cardiovascular (CV) events, and to develop a prediction model that could be used to risk stratify patients with stable CHD., Methods and Results: We used independent derivation (912 participants in the Heart and Soul Study) and validation (2876 participants in the PEACE trial) cohorts of patients with stable CHD to develop a risk prediction model using Cox proportional hazards models. The outcome was CV events, defined as myocardial infarction, stroke, or CV death. The annual rate of CV events was 3.4% in the derivation cohort and 2.2% in the validation cohort. With the exception of smoking, traditional risk factors (including age, sex, body mass index, hypertension, dyslipidemia, and diabetes) did not emerge as the top predictors of secondary CV events. The top 4 predictors of secondary events were the following: N-terminal pro-type brain natriuretic peptide, high-sensitivity cardiac troponin T, urinary albumin:creatinine ratio, and current smoking. The 5-year C-index for this 4-predictor model was 0.73 in the derivation cohort and 0.65 in the validation cohort. As compared with variables in the Framingham secondary events model, the Heart and Soul risk model resulted in net reclassification improvement of 0.47 (95% CI 0.25 to 0.73) in the derivation cohort and 0.18 (95% CI 0.01 to 0.40) in the validation cohort., Conclusions: Novel risk factors are superior to traditional risk factors for predicting 5-year risk of secondary events in patients with stable CHD., (© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)
- Published
- 2015
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