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Multimarker prediction of coronary heart disease risk: the Women's Health Initiative

Authors
 Hyeon Chang Kim  ;  Philip Greenland  ;  Jacques E. Rossouw  ;  JoAnn E. Manson  ;  Barbara B. Cochrane  ;  Norman L. Lasser  ;  Marian C. Limacher  ;  Donald M. Lloyd-Jones  ;  Karen L. Margolis  ;  Jennifer G. Robinson 
Citation
 Journal of the American College of Cardiology, Vol.55(19) : 2080-2091, 2010 
Journal Title
 Journal of the American College of Cardiology 
ISSN
 0735-1097 
Issue Date
2010
Abstract
OBJECTIVES: The aim of this study was to investigate whether multiple biomarkers contribute to improved coronary heart disease (CHD) risk prediction in post-menopausal women compared with assessment using traditional risk factors (TRFs) only. BACKGROUND: The utility of newer biomarkers remains uncertain when added to predictive models using only TRFs for CHD risk assessment. METHODS: The Women's Health Initiative Hormone Trials enrolled 27,347 post-menopausal women ages 50 to 79 years. Associations of TRFs and 18 biomarkers were assessed in a nested case-control study including 321 patients with CHD and 743 controls. Four prediction equations for 5-year CHD risk were compared: 2 Framingham risk score covariate models; a TRF model including statin treatment, hormone treatment, and cardiovascular disease history as well as the Framingham risk score covariates; and an additional biomarker model that additionally included the 5 significantly associated markers of the 18 tested (interleukin-6, d-dimer, coagulation factor VIII, von Willebrand factor, and homocysteine). RESULTS: The TRF model showed an improved C-statistic (0.729 vs. 0.699, p = 0.001) and net reclassification improvement (6.42%) compared with the Framingham risk score model. The additional biomarker model showed additional improvement in the C-statistic (0.751 vs. 0.729, p = 0.001) and net reclassification improvement (6.45%) compared with the TRF model. Predicted CHD risks on a continuous scale showed high agreement between the TRF and additional biomarker models (Spearman's coefficient = 0.918). Among the 18 biomarkers measured, C-reactive protein level did not significantly improve CHD prediction either alone or in combination with other biomarkers. CONCLUSIONS: Moderate improvement in CHD risk prediction was found when an 18-biomarker panel was added to predictive models using TRFs in post-menopausal women.
Full Text
http://www.sciencedirect.com/science/article/pii/S0735109710009010
DOI
10.1016/j.jacc.2009.12.047
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyeon Chang(김현창) ORCID logo https://orcid.org/0000-0001-7867-1240
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/100861
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