Multiple cardiac biomarkers to improve prediction of cardiovascular events: Findings from the Generation Scotland Scottish Family Health Study

Paul Welsh*, Dorien M. Kimenai, Anoop S. V. Shah, Danni A. Gadd, Riccardo E Marioni, Mark Woodward, Cathie L M Sudlow, Archie Campbell, John G F Cleland, Pierpaolo Pellicori, Caroline Hayward, Nicholas L Mills, Naveed Sattar

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background: Many studies have investigated whether single cardiac biomarkers improve cardiovascular risk prediction for primary prevention but whether a combined approach could further improve risk prediction is unclear. We aimed to test a sex-specific combined cardiac biomarker approach for cardiovascular risk prediction.
Methods: In the Generation Scotland Scottish Family Health Study, N-terminal pro-B-type natriuretic peptide (NT-proBNP), growth differentiation factor-15 (GDF-15), cardiac troponin I (cTnI), cardiac troponin T (cTnT), and C-reactive protein (CRP) were measured in stored serum using automated immunoassays. Sex-specific Cox models that included SCORE2 risk factors evaluated addition of single and combined biomarkers for prediction of major adverse cardiovascular events (MACE). Combined biomarker models were compared to a baseline model that included SCORE2 factors.
Results: The study population comprised 18,383 individuals (58.9% women, median age of 48 years [25th-75th percentile, 35-58 years]). During the median follow up of 11.6 (25th-75th percentile, 10.8-13.0) years, MACE occurred in 942 (5.1%) individuals. The greatest increase in discrimination with addition of individual biomarkers to base model was for women GDF-15 and for men NT-proBNP (change in c-index: +0.010 for women and +0.005 for men). For women, combined biomarker models that included GDF-15 and NT-proBNP (+0.012) or GDF-15 and cTnI (+0.013), but not CRP or cTnT, further improved discrimination. For men, combined biomarker models that included NT-proBNP and GDF-15 (+0.007), NT-proBNP and cTnI (+0.006), or NT-proBNP and CRP (+0.008), but not cTnT, further improved discrimination.
Conclusions: A combined biomarker approach, particularly the use of GDF-15, NT-proBNP and cTnI, further refined cardiovascular risk estimates.
Original languageEnglish
JournalClinical Chemistry
DOIs
Publication statusPublished - 9 Dec 2023

Keywords / Materials (for Non-textual outputs)

  • Biomarkers
  • cardiovascular
  • risk factors
  • general population

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