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An assessment of incremental coronary risk prediction using C-reactive protein and other novel risk markers: the atherosclerosis risk in communities study.

Abstract

BACKGROUND

There has been interest in recent years in whether additional, and in particular novel, risk factors or blood markers, such as C-reactive protein, can enhance existing coronary heart disease (CHD) prediction models.

METHODS

Using a series of case-cohort studies, the prospective Atherosclerosis Risk in Communities (ARIC) Study assessed the association of 19 novel risk markers with incident CHD in 15,792 adults followed up since 1987-1989. Novel markers included measures of inflammation, endothelial function, fibrin formation, fibrinolysis, B vitamins, and antibodies to infectious agents. Change in the area under the receiver operating characteristic curve (AUC) was used to assess the additional contribution of novel risk markers to CHD prediction beyond that of traditional risk factors.

RESULTS

The basic risk factor model, which included traditional risk factors (age, race, sex, total and high-density lipoprotein cholesterol levels, systolic blood pressure, antihypertensive medication use, smoking status, and diabetes), predicted CHD well, as evidenced by an AUC of approximately 0.8. The C-reactive protein level did not add significantly to the AUC (increase in AUC of 0.003), and neither did most other novel risk factors. Of the 19 markers studied, lipoprotein-associated phospholipase A(2), vitamin B(6), interleukin 6, and soluble thrombomodulin added the most to the AUC (range, 0.006-0.011).

CONCLUSIONS

Our findings suggest that routine measurement of these novel markers is not warranted for risk assessment. On the other hand, our findings reinforce the utility of major, modifiable risk factor assessment to identify individuals at risk for CHD for preventive action.

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  • Authors+Show Affiliations

    ,

    Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454-1015, USA. folsom@epi.umn.edu

    , , , , , , , , ,

    Source

    Archives of internal medicine 166:13 2006 Jul 10 pg 1368-73

    MeSH

    1-Alkyl-2-acetylglycerophosphocholine Esterase
    Age Factors
    Aged
    Antihypertensive Agents
    Biomarkers
    Blood Pressure
    C-Reactive Protein
    Cholesterol
    Coronary Disease
    Diabetes Mellitus
    Female
    Humans
    Interleukin-6
    Male
    Middle Aged
    Phospholipases A
    Prospective Studies
    ROC Curve
    Risk Assessment
    Risk Factors
    Sex Factors
    Smoking
    Thrombomodulin
    United States
    Vitamin B 6

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    16832001

    Citation

    Folsom, Aaron R., et al. "An Assessment of Incremental Coronary Risk Prediction Using C-reactive Protein and Other Novel Risk Markers: the Atherosclerosis Risk in Communities Study." Archives of Internal Medicine, vol. 166, no. 13, 2006, pp. 1368-73.
    Folsom AR, Chambless LE, Ballantyne CM, et al. An assessment of incremental coronary risk prediction using C-reactive protein and other novel risk markers: the atherosclerosis risk in communities study. Arch Intern Med. 2006;166(13):1368-73.
    Folsom, A. R., Chambless, L. E., Ballantyne, C. M., Coresh, J., Heiss, G., Wu, K. K., ... Sharrett, A. R. (2006). An assessment of incremental coronary risk prediction using C-reactive protein and other novel risk markers: the atherosclerosis risk in communities study. Archives of Internal Medicine, 166(13), pp. 1368-73.
    Folsom AR, et al. An Assessment of Incremental Coronary Risk Prediction Using C-reactive Protein and Other Novel Risk Markers: the Atherosclerosis Risk in Communities Study. Arch Intern Med. 2006 Jul 10;166(13):1368-73. PubMed PMID: 16832001.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - An assessment of incremental coronary risk prediction using C-reactive protein and other novel risk markers: the atherosclerosis risk in communities study. AU - Folsom,Aaron R, AU - Chambless,Lloyd E, AU - Ballantyne,Christie M, AU - Coresh,Josef, AU - Heiss,Gerardo, AU - Wu,Kenneth K, AU - Boerwinkle,Eric, AU - Mosley,Thomas H,Jr AU - Sorlie,Paul, AU - Diao,Guoqing, AU - Sharrett,A Richey, PY - 2006/7/13/pubmed PY - 2006/9/1/medline PY - 2006/7/13/entrez SP - 1368 EP - 73 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 166 IS - 13 N2 - BACKGROUND: There has been interest in recent years in whether additional, and in particular novel, risk factors or blood markers, such as C-reactive protein, can enhance existing coronary heart disease (CHD) prediction models. METHODS: Using a series of case-cohort studies, the prospective Atherosclerosis Risk in Communities (ARIC) Study assessed the association of 19 novel risk markers with incident CHD in 15,792 adults followed up since 1987-1989. Novel markers included measures of inflammation, endothelial function, fibrin formation, fibrinolysis, B vitamins, and antibodies to infectious agents. Change in the area under the receiver operating characteristic curve (AUC) was used to assess the additional contribution of novel risk markers to CHD prediction beyond that of traditional risk factors. RESULTS: The basic risk factor model, which included traditional risk factors (age, race, sex, total and high-density lipoprotein cholesterol levels, systolic blood pressure, antihypertensive medication use, smoking status, and diabetes), predicted CHD well, as evidenced by an AUC of approximately 0.8. The C-reactive protein level did not add significantly to the AUC (increase in AUC of 0.003), and neither did most other novel risk factors. Of the 19 markers studied, lipoprotein-associated phospholipase A(2), vitamin B(6), interleukin 6, and soluble thrombomodulin added the most to the AUC (range, 0.006-0.011). CONCLUSIONS: Our findings suggest that routine measurement of these novel markers is not warranted for risk assessment. On the other hand, our findings reinforce the utility of major, modifiable risk factor assessment to identify individuals at risk for CHD for preventive action. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/16832001/full_citation L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.166.13.1368 DB - PRIME DP - Unbound Medicine ER -