Contribution of 30 Biomarkers to 10-Year Cardiovascular Risk Estimation in 2 Population Cohorts The Archiving,

Background —Cardiovascular risk estimation by novel biomarkers needs assessment in disease-free population cohorts, followed up for incident cardiovascular events, assaying the serum and plasma archived at baseline. We report results from 2 cohorts in such a continuing study. Methods and Results —Thirty novel biomarkers from different pathophysiological pathways were evaluated in 7915 men and women of the FINRISK97 population cohort with 538 incident cardiovascular events at 10 years (fatal or nonfatal coronary or stroke events), from which a biomarker score was developed and then validated in the 2551 men of the Belfast Prospective Epidemiological Study of Myocardial Infarction (PRIME) cohort (260 events). No single biomarker consistently improved risk estimation in FINRISK97 men and FINRISK97 women and the Belfast PRIME Men cohort after allowing for confounding factors; however, the strongest associations (with hazard ratio per SD in FINRISK97 men) were found for N-terminal pro-brain natriuretic peptide (1.23), C-reactive protein (1.23), B-type natriuretic peptide (1.19), and sensitive troponin I (1.18). A biomarker score was developed from the FINRISK97 cohort with the use of regression coefficients and lasso methods, with selection of troponin I, C-reactive protein, and N-terminal pro-brain natriuretic peptide. Adding this score to a conventional risk factor model in the Belfast PRIME Men cohort validated it by improved c-statistics ( P (cid:1) 0.004) and integrated discrimination ( P (cid:2) 0.0001) and led to significant reclassification of individuals into risk categories ( P (cid:1) 0.0008). Conclusions —The addition of a biomarker score including N-terminal pro-brain natriuretic peptide, C-reactive protein, and sensitive troponin I to a conventional risk model improved 10-year risk estimation for cardiovascular events in 2 middle-aged European populations. Further validation is needed in other populations and age groups. ( Circulation . 2010;121:2388-2397.) We examined 30 novel biomarkers representing different pathophysiological pathways in 7915 men and women of the population-based FINRISK97 cohort with 538 incident cardiovascular events at 10 years of follow-up. We then developed a biomarker score from the best biomarkers and validated the score in the 2551 men of the Belfast Prospective Epidemiological Study of Myocardial Infarction (PRIME) cohort with 260 incident cardiovascular events at 10 years of follow-up. The strongest associations with the risk for future cardiovascular events in FINRISK97 were found for N-terminal pro-brain natriuretic peptide, C-reactive protein, brain natriuretic peptide, and sensitive troponin I. In addition to pathophysiological considerations, application of different statistical methods consistently resulted in selection of troponin I, C-reactive protein, and N-terminal pro-brain natriuretic peptide for the Contexte —Il est fréquent qu’un patient diabétique soit hospitalisé pour un infarctus myocardique aigu (IMA) alors qu’il suit un traitement hypoglycémiant et qu’il quitte ensuite l’hôpital sans prescription de ce type. Nous avons cherché à déterminer la fréquence de cette pratique ainsi que ses conséquences cliniques en termes de réhospitalisation et de mortalité. Méthodes et résultats —Nous avons mené une étude rétrospective sur 24 953 diabétiques affiliés à Medicare qui avaient été hospita-lisés pour un IMA et étaient ensuite rentrés chez eux. Nous avons évalué la fréquence des arrêts du traitement hypoglycémiant à la sortie d’hôpital chez les patients qui en suivaient un à leur arrivée. Nous avons, par ailleurs, utilisé des modèles de risques proportionnels multivariés de Cox ajustés en fonction du patient, du médecin et des variables hospitalières pour établir le lien indépendant existant entre la sortie d’hôpital, selon que celle-ci avait ou non donné lieu à la prescription d’un traitement hypoglycémiant, et la survenue d’un événement clinique à un an. Le critère de jugement principal a été le délai de survenue du décès au cours de l’année ayant suivi la sortie d’hôpital