Cardiovascular Risk Assessment in Older Adults Improved With Biomarkers

The addition of biomarkers to the Pooled Cohort Equation (PCE) or use of a simpler lab model markedly improved short-term cardiovascular disease risk prediction, according to a Young Investigator Award presentation by Anum Saeed, MD, at ACC.18. The study was simultaneously published in the Journal of the American College of Cardiology.

ACC/American Heart Association guidelines recommend the PCE to estimate 10-year risk for atherosclerotic cardiovascular disease (ASCVD) events, but the usefulness of the PCE is limited in older adults. The researchers evaluated whether adding biomarkers to the PCE would enhance risk prediction in older adults >79 years over a shorter time frame.

Participants included 4,760 individuals (mean age, 75.4 years) without prevalent cardiovascular disease or heart failure from the Atherosclerosis Risk in Communities (ARIC) study recruited in 1987-1989 who completed Visit 5 in 2011-2013. Risk for cardiovascular events was assessed using three tools: PCE alone; PCE plus N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT) and high-sensitivity C-reactive protein (hs-CRP); and a lab model that included biomarkers, age, race and sex. Biomarkers were measured at Visit 5. The patients were followed for cardiovascular events from Visit 5 through 2015.

Over a median follow-up of approximately four years, incident heart failure was the most common cardiovascular event (n=193), followed by coronary heart disease (n=118) and stroke (n=81) events. NT-proBNP and hs-cTnT each were significantly associated with incident global cardiovascular disease, ASCVD, coronary heart disease, stroke and heart failure. hs-CRP was significantly associated with all but stroke. The hazard ratios and four-year absolute risk for all outcomes significantly increased across increasing concentrations of both hs-cTnT and NT-proBNP. The four-year absolute risk increased across hs-CRP concentrations for global cardiovascular disease and heart failure.

Compared with the PCE, addition of each biomarker significantly improved risk prediction, with the greatest improvement occurring with addition of all three biomarkers. The lab model also improved short-term risk prediction. The PCE alone overestimated participants with low risk and underestimated those with high risk over four years compared with models using biomarkers.                                                                                                                

Improved risk assessment with the addition of biomarkers or use of a simpler lab model may be useful for joint decision making on initiation and intensity of preventive therapies in older adults, according to the investigators. Confirmation of these results in other cohorts as well as examination of cost-effectiveness is warranted.

Clinical Topics: Anticoagulation Management, Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: ACC18, ACC Annual Scientific Session, Natriuretic Peptide, Brain, C-Reactive Protein, Troponin T, Cardiovascular Diseases, Cost-Benefit Analysis, Follow-Up Studies, Risk Factors, Peptide Fragments, Heart Failure, Atherosclerosis, Myocardial Infarction, Risk Assessment, Coronary Disease, Biological Markers, Stroke, Decision Making

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