A multiple biomarker risk score for guiding clinical decisions using a decision curve approach

• Published in: European journal of preventive cardiology 2012-08, Vol.19 (4), p.874-884
• Main Authors: Hughes, Maria F, Saarela, Olli, Blankenberg, Stefan, Zeller, Tanja, Havulinna, Aki S, Kuulasmaa, Kari, Yarnell, John, Schnabel, Renate B, Tiret, Laurence, Salomaa, Veikko, Evans, Alun, Kee, Frank
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Biomarkers - blood; Blood Pressure; C-Reactive Protein - analysis; Cardiovascular Diseases - blood; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - physiopathology; Cholesterol - blood; Decision Support Techniques; Europe; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment; Risk Factors; Sex Factors; Troponin I - blood
• ISSN: 2047-4873; 2047-4881
• DOI: 10.1177/1741826711417341

Aims: We assessed whether a cardiovascular risk model based on classic risk factors (e.g. cholesterol, blood pressure) could refine disease prediction if it included novel biomarkers (C-reactive protein, N-terminal pro-B-type natriuretic peptide, troponin I) using a decision curve approach which can incorporate clinical consequences. Methods and results: We evaluated whether a model including biomarkers and classic risk factors could improve prediction of 10 year risk of cardiovascular disease (CVD; chronic heart disease and ischaemic stroke) against a classic risk factor model using a decision curve approach in two prospective MORGAM cohorts. This included 7739 men and women with 457 CVD cases from the FINRISK97 cohort; and 2524 men with 259 CVD cases from PRIME Belfast. The biomarker model improved disease prediction in FINRISK across the high-risk group (20⊟40%) but not in the intermediate risk group, at the 23% risk threshold net benefit was 0.0033 (95% CI 0.0013−0.0052). However, in PRIME Belfast the net benefit of decisions guided by the decision curve was improved across intermediate risk thresholds (10⊟20%). At pt = 10% in PRIME, the net benefit was 0.0059 (95% CI 0.0007⊟0.0112) with a net increase in 6 true positive cases per 1000 people screened and net decrease of 53 false positive cases per 1000 potentially leading to 5% fewer treatments in patients not destined for an event. Conclusion: The biomarker model improves 10-year CVD prediction at intermediate and high-risk thresholds and in particular, could be clinically useful at advising middle-aged European males of their CVD risk.