Single and multiple cardiovascular biomarkers in subjects without a previous cardiovascular event
A new article in the European Journal of Preventive Cardiology by Danish Diabetes Academy fellow Manan Pareek, MD, PhD, Region Zealand and Brigham and Women’s Hospital, shows that the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and growth differentiation factor 15 (GDF-15) each enhance prognostication beyond traditional cardiovascular risk factors, glucose levels, renal function, and echocardiography in individuals without known cardiovascular disease.
PREDICTION OF CARDIOVASCULAR RISK
Robust risk assessment in subjects without a previous cardiovascular event remains challenging. Circulating cardiovascular biomarkers are easily obtained and may reflect the pathophysiological mechanisms that contribute to the adverse risk of clinical outcomes. Data exploring prognostic properties of such biomarkers in asymptomatic individuals, in the context of subclinical cardiovascular alterations observed on echocardiography, are limited.
BIOMARKERS AND INCIDENT EVENTS
Manan Pareek and his group conducted a prospective, population-based cohort study to assess the incremental prognostic value of six blood biomarkers, individually and combined, in predicting incident cardiovascular events and mortality among 1,324 asymptomatic subjects (median age 66 years; 413 (31%) female) from the general population.
During median 8.6 follow-up years, 368 (28%) composite events occurred. Separate addition of NT-proBNP and GDF-15 to traditional risk factors, medications, and echocardiographic measurements provided significant improvements in discriminative ability.
Both biomarkers remained significant predictors of outcome upon inclusion in the same model, although the addition of GDF-15 to a model already including NT-proBNP only resulted in marginally significantly improved performance. Adding a third, fourth, fifth, and sixth biomarker was not useful.
CLINICAL PERSPECTIVES
According to Manan Parrek, their study may not provide a definitive answer to whether multiple biomarker strategies are superior to single biomarker strategies, but careful selection of biomarkers should be preferred rather than relying solely on quantity and theoretical properties.
"There is a need for interventional studies in which thresholds based on single and multiple biomarker panels guide therapeutic measures", he concludes.
SUMMARY
NT-proBNP and GDF-15 offered initial promise as biomarkers for risk refinement beyond traditional cardiovascular risk factors, glucose levels, renal function, and echocardiography.
AUTHORS AND AFFILIATIONS
Manan Pareek, MD, PhD1,2,3; Deepak L. Bhatt, MD, MPH1;Muthiah Vaduganathan, MD, MPH1; Tor Biering-Sørensen, MD, PhD1,4; Arman Qamar, MD1; Axel C. P. Diederichsen, MD, PhD5; Jacob Eifer Møller, MD, PhD, DMSc5; Peter Hindersson, MD6; Margrét Leósdóttir, MD, PhD7; Martin Magnusson, MD, PhD7; Peter M. Nilsson, MD, PhD8; Michael H. Olsen, MD, PhD, DMSc3
1Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
2Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
3Cardiology Section, Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark
4Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
5Department of Cardiology, Odense University Hospital, Odense, Denmark
6Department of Clinical Biochemistry, Regional Hospital of Northern Jutland, Hjørring, Denmark
7Department of Cardiology, Skåne University Hospital, Malmö, Sweden
8Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden