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Biomarker‐based risk prediction in the community
Author(s) -
AbouEzzeddine Omar F.,
McKie Paul M.,
Scott Christopher G.,
Rodeheffer Richard J.,
Chen Horng H.,
Michael Felker G.,
Jaffe Allan S.,
Burnett John C.,
Redfield Margaret M.
Publication year - 2016
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.663
Subject(s) - mace , medicine , biomarker , heart failure , cohort , natriuretic peptide , hazard ratio , brain natriuretic peptide , cardiology , intensive care medicine , myocardial infarction , percutaneous coronary intervention , confidence interval , biochemistry , chemistry
Aims Guided by predictive characteristics of cardiovascular biomarkers, we explored the clinical implications of a simulated biomarker‐guided heart failure ( HF ) and major adverse cardiovascular events ( MACE ) prevention strategy in the community. Methods and results In a community cohort ( n = 1824), the predictive characteristics for HF and MACE of galectin‐3 (Gal‐3), ST2 , high‐sensitivity cardiac troponin I ( hscTnI ), high‐sensitivity C‐reactive protein ( hsCRP ), N ‐terminal pro‐brain natriuretic peptide ( NT‐proBNP ) and B‐type natriuretic peptide ( BNP ) were established. We performed number needed to screen ( NNS ) and treat (NNT) with the intervention analyses according to biomarker screening strategy and intervention efficacy in persons with at least one cardiovascular risk factor. In the entire cohort, for both HF and MACE , the predictive characteristics of NT‐proBNP and hscTnI were superior to other biomarkers; alone, in a multimarker model, and adjusting for clinical risk factors. An NT‐proBNP ‐guided preventative intervention with an intervention effect size (4‐year hazard ratio for intervention in biomarker positive cohort) of ≤0.7 would reduce the global burden of HF by ≥20% and MACE by ≥15%. From this simulation, the NNS to prevent one HF event or MACE in 4 years would be ≤100 with a NNT to prevent one HF event of ≤20 and one MACE of ≤10. Conclusions The predictive characteristics of NT‐proBNP and hscTnI for HF or MACE in the community are superior to other biomarkers. Biomarker‐guided preventative interventions with reasonable efficacy would compare favourably to established preventative interventions. This data provides a framework for biomarker selection which may inform design of biomarker‐guided preventative intervention trials.