- 作者：Br¨ªain ? Hartaigh ; G. Neil Thomas ; Jos A. Bosch ; Karla Hemming ; Stefan Pilz ; Adrian Loerbroks ; Marcus E. Kleber ; Tanja B. Grammer ; Joachim E. Fischer ; Guenther Silbernagel ; Andreas Tomaschitz ; Winfried M?rz
- 关键词：Cardiovascular ; Risk factor ; Biomarker ; Discrimination ; Reclassification
- 刊名：International Journal of Cardiology
- 出版年：2013
- 出版时间：3 October, 2013
- 年：2013
- 卷：168
- 期：3
- 页码：2609-2615
- 全文大小：326 K
Background
Conventional factors do not fully explain the distribution of cardiovascular outcomes. Biomarkers are known to participate in well-established pathways associated with cardiovascular disease, and may therefore provide further information over and above conventional risk factors. This study sought to determine whether individual and/or combined assessment of 9 biomarkers improved discrimination, calibration and reclassification of cardiovascular mortality.Methods
3267 patients (2283 men), aged 18-95 years, at intermediate-to-high-risk of cardiovascular disease were followed in this prospective cohort study. Conventional risk factors and biomarkers were included based on forward and backward Cox proportional stepwise selection models.
Results
During 10-years of follow-up, 546 fatal cardiovascular events occurred. Four biomarkers (interleukin-6, neutrophils, von Willebrand factor, and 25-hydroxyvitamin D) were retained during stepwise selection procedures for subsequent analyses. Simultaneous inclusion of these biomarkers significantly improved discrimination as measured by the C-index (0.78, P = 0.0001), and integrated discrimination improvement (0.0219, P < 0.0001). Collectively, these biomarkers improved net reclassification for cardiovascular death by 10.6 % (P < 0.0001) when added to the conventional risk model.
Conclusions
In terms of adverse cardiovascular prognosis, a biomarker panel consisting of interleukin-6, neutrophils, von Willebrand factor, and 25-hydroxyvitamin D offered significant incremental value beyond that conveyed by simple conventional risk factors.