Framework for Evaluating Novel Risk Markers
Authors: Mark A. Hlatky
Journal: Annals of Internal Medicine (2012)

Editorials20 March 2012Framework for Evaluating Novel Risk MarkersMark A. Hlatky, MDMark A. Hlatky, MDFrom Stanford University School of Medicine, Stanford, CA 94305-5405.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-6-201203200-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Coronary heart disease (CHD) is characterized by the sudden onset of often catastrophic symptoms after decades of silent and insidious development. Identifying persons at risk for clinically evident CHD has become an important strategy for prevention, because treatment can reduce risk. The Framingham Heart Study, which began more than 60 years ago, pioneered the identification of clinical factors that were associated with future coronary events (1). Data on these classic risk factors—age, sex, blood pressure, cholesterol levels, diabetes, and smoking—can be combined using the Framingham risk score (FRS) to estimate a person's chance of developing CHD over the next 10 ...References1. Kannel WB, McGee D, Gordon T. A general cardiovascular risk profile: the Framingham Study. Am J Cardiol. 1976;38:46-51. [PMID: 132862] CrossrefMedlineGoogle Scholar2. D'Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117:743-53. [PMID: 18212285] CrossrefMedlineGoogle Scholar3. D'Agostino RB, Grundy S, Sullivan LM, Wilson P; CHD Risk Prediction Group. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA. 2001;286:180-7. [PMID: 11448281] CrossrefMedlineGoogle Scholar4. Cooney MT, Dudina AL, Graham IM. Value and limitations of existing scores for the assessment of cardiovascular risk: a review for clinicians. J Am Coll Cardiol. 2009;54:1209-27. [PMID: 19778661] CrossrefMedlineGoogle Scholar5. Tzoulaki I, Liberopoulos G, Ioannidis JP. Assessment of claims of improved prediction beyond the Framingham risk score. JAMA. 2009;302:2345-52. [PMID: 19952321] CrossrefMedlineGoogle Scholar6. Hlatky MA, Greenland P, Arnett DK, Ballantyne CM, Criqui MH, Elkind MS, et al; American Heart Association Expert Panel on Subclinical Atherosclerotic Diseases and Emerging Risk Factors and the Stroke Council. Criteria for evaluation of novel markers of cardiovascular risk: a scientific statement from the American Heart Association. Circulation. 2009;119:2408-16. [PMID: 19364974] CrossrefMedlineGoogle Scholar7. Harrell FE, Califf RM, Pryor DB, Lee KL, Rosati RA. Evaluating the yield of medical tests. JAMA. 1982;247:2543-6. [PMID: 7069920] CrossrefMedlineGoogle Scholar8. Pencina MJ, D'Agostino RB, D'Agostino RB, Vasan RS. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med. 2008;27:157-72. [PMID: 17569110] CrossrefMedlineGoogle Scholar9. Janes H, Pepe MS, Gu W. Assessing the value of risk predictions by using risk stratification tables. Ann Intern Med. 2008;149:751-60. [PMID: 19017593] LinkGoogle Scholar10. Kavousi M, Elias-Smale S, Rutten JH, Leening MJ, Vliegenthart R, Verwoert GC, et al. Evaluation of newer risk markers for coronary heart disease risk classification. A cohort study. Ann Intern Med. 2012;156:438-44. LinkGoogle Scholar11. Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, et al; American College of Cardiology Foundation. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2010;56:50-103. [PMID: 21144964] CrossrefMedlineGoogle Scholar12. Pletcher MJ, Pignone M. Evaluating the clinical utility of a biomarker: a review of methods for estimating health impact. Circulation. 2011;123:1116-24. [PMID: 21403122] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Stanford University School of Medicine, Stanford, CA 94305-5405.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0276.Corresponding Author: Mark A. Hlatky, MD, Stanford University School of Medicine, HRP Redwood Building, Room T150, 259 Campus Drive, Stanford, CA 94305-5405; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEvaluation of Newer Risk Markers for Coronary Heart Disease Risk Classification Maryam Kavousi , Suzette Elias-Smale , Joost H.W. Rutten , Maarten J.G. Leening , Rozemarijn Vliegenthart , Germaine C. Verwoert , Gabriel P. Krestin , Matthijs Oudkerk , Moniek P.M. de Maat , Frank W.G. Leebeek , Francesco U.S. Mattace-Raso , Jan Lindemans , Albert Hofman , Ewout W. Steyerberg , Aad van der Lugt , Anton H. van den Meiracker , and Jacqueline C.M. Witteman Metrics Cited BySystematic Review of Health Economic Impact Evaluations of Risk Prediction Models: Stop Developing, Start EvaluatingImproving prediction models with new markers: a comparison of updating strategiesCoronary Artery Calcium and Incident Cerebrovascular Events in an Asymptomatic CohortMediation of Cardiovascular Risk Factor Effects Through Subclinical Vascular DiseaseNet Reclassification Improvement: Computation, Interpretation, and Controversies A Literature Review and Clinician's GuideMaarten J.G. Leening, MD, MSc, Moniek M. Vedder, MSc, Jacqueline C.M. Witteman, PhD, Michael J. Pencina, PhD, and Ewout W. Steyerberg, PhDMortality Among Patients Who Receive or Defer GastrostomiesDevelopment of a Multi-institutional Cohort to Facilitate Cardiovascular Disease Biomarker Validation Using Existing Biorepository Samples Linked to Electronic Health RecordsClinical utility of genetic risk testing in primary care: the example of Type 2 diabetesHypertension and stable coronary artery diseaseComparison of absolute serum creatinine changes versus Kidney Disease: Improving Global Outcomes consensus definitions for characterizing stages of acute kidney injuryScreening in Pediatrics—More Questions than Answers? 20 March 2012Volume 156, Issue 6Page: 468-469KeywordsBiomarkersC-reactive proteinsCoronary heart diseaseDrugsStatins ePublished: 20 March 2012 Issue Published: 20 March 2012 CopyrightCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...