The aim of this study was to investigate the contribution of multiple biomarkers to the risk assessment of coronary heart disease (CHD) compared to traditional risk factors in post-menopausal women aged 50 to 79 years. For that purpose, 18 biomarkers were assessed in a nested case-control study including 321 patients with CHD and 743 controls. Among the 18 biomarkers examined, only interleukin-6 (IL-6), D-dimer, factor VIII, von Willebrand factor, and homocysteine levels were independently associated with CHD. Different models were developed to assess 5-year CHD risk. The traditional risk factor model, which included statin and hormone treatments and history of cardiovascular disease at baseline in addition to traditional risk factors, showed an improved C-statistic as compared to the Framingham risk score (0.729 vs. 0.699, p=0.001). In another model that included the addition of 5 biomarkers, the C-statistic further increased to 0.751 (p=0.001 compared to traditional risk factor model), and the corresponding net reclassification improvement (NRI) was 6.45% in women who were free of cardiovascular disease at baseline. Thus, these findings suggest that adding biomarkers to traditional risk factors did not improve considerably CHD risk prediction in post-menopausal women. In his comment, Wang TJ underlined the important limitation of this study such as the case-control design which does not allow accurate assessment of model calibration and NRI, the absence of two important biomarkers such as B-type natriuretic peptide and urinary albumin excretion in the analysis and the inclusion of patients with prevalent cardiovascular disease. However, he qualified this study as valuable and timely as well as an ongoing reminder of the importance of conventional risk factors in cardiovascular risk assessment.
Documentation centre