Contribution of 30 biomarkers to 10-year cardiovascular risk estimation in 2 population cohorts: the MONICA, risk, genetics, archiving, and monograph (MORGAM) biomarker project.

Description

This large-scale study was conducted to evaluate the added value of 30 biomarkers that represent various known pathways for cardiovascular disease (CVD) compared to easily available traditional risk factors for cardiovascular risk assessment in 10,466 individuals from two European population-based studies. A total of 798 incident CVD events were recorded during a 10-year follow-up. The strongest associations with incident cardiovascular events across the two cohorts in both men and women were found for well established cardiovascular biomarkers such as C-reactive protein (CRP), N-terminal pro B-type natriuretic peptide (NT-proBNP), and troponin I. However, adding any single biomarker separately to the established risk model did not improve risk estimation in both cohorts. The authors developed a biomarker score from the best biomarkers and validated the score in one of the cohorts. The elaboration of this score with the use of different statistical methods resulted in the selection of CRP, NT-proBNP and troponin I which are nonredundant biomarkers of different pathophysiological pathways. The incorporation of this score to the established risk model significantly improved risk estimation and led to significant reclassification of individuals into risk categories. These findings suggest that the inclusion of a biomarker score that includes CRP, NT-proBNP and troponin I into a standard risk model refined the 10-year risk assessment for cardiovascular events.

In their editorial comment, de Lemos JA and Rohatgi A underlined several strenghts of this study such as it being the first biomarker project of this magnitude in the cardiovascular field; its well designed and validated biomarker score; and the rigorous analysis of the data to evaluate the contribution of the biomarkers to the traditional risk model. However, they highlighted the fact that the reclassification analyses were performed only in the PRIME Belfast cohort which enrolled a much narrower age range of individuals therefore providing readily favourable results of the biomarker score. Thus, they encouraged the conduct of many studies to investigate new biomarkers as well as to understand the clinical implication of incorporating the more robust biomarkers into the assessment of cardiovascular risk.