Multimarker Prediction of Coronary Heart Disease Risk. The Women's Health Initiative

Hyeon Chang Kim, Philip Greenland*, Jacques E. Rossouw, Jo Ann E. Manson, Barbara B. Cochrane, Norman L. Lasser, Marian C. Limacher, Donald M. Lloyd-Jones, Karen L. Margolis, Jennifer G. Robinson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

94 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2080-2091
Number of pages12
JournalJournal of the American College of Cardiology
Volume55
Issue number19
DOIs
StatePublished - May 11 2010

Keywords

  • biomarker
  • coronary heart disease
  • prediction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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