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

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.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Kim HC,Greenland P,Rossouw JE,Manson JE,Cochrane BB,Lasser NL,Limacher MC,Lloyd-Jones DM,Margolis KL,Robinson JG

doi

10.1016/j.jacc.2009.12.047

subject

Has Abstract

pub_date

2010-05-11 00:00:00

pages

2080-91

issue

19

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(10)00901-0

journal_volume

55

pub_type

杂志文章

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