Investigators of the Uppsala Longitudinal Study of Adult Men (ULSAM) followed 1,135 men (mean age = 71 years at baseline) for a mean follow-up of 10 years during which 136 men died from cardiovascular disease (CVD). The objective of the study was to investigate whether markers of myocardial cell damage, left ventricular dysfunction, renal failure, and inflammation (troponin I, N-terminal pro-brain natriuretic peptide, cystatin C, and C-reactive protein) improved cardiovascular risk prediction on top of established CVD risk factors. Each marker was positively associated with CVD risk, with the odds ratio for future CVD ranging from 1.36 to 2.16 (95% CI, 1.05-3.00). The established risk factors yielded a C statistic of 0.688 for incident CVD, and the addition of the 4 risk factors elevated the C statistic to 0.748 (p=0.03). Based on these results, the authors noted that these risk factors should be considered in clinical practice to better estimate CVD risk. The paper was accompanied by an editorial by de Lemos and Lloyd-Jones who highlighted the fact that despite decades of research on CVD biomarkers, risk prediction with emerging biomarkers seems to have made only marginal progress. The authors also suggested that the results of ULSAM were relevant because of the novelty of the biomarkers studied. They also noted that other studies in women or younger men from multiple ethnic groups should be performed in order to gauge how the measurement of such biomarkers could be incorporated in daily clinical practice.
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