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An assessment of incremental coronary risk prediction using C-reactive protein and other novel risk markers: the atherosclerosis risk in communities study.

TitleAn assessment of incremental coronary risk prediction using C-reactive protein and other novel risk markers: the atherosclerosis risk in communities study.
Publication TypeJournal Article
Year of Publication2006
AuthorsFolsom AR, Chambless LE, Ballantyne CM, Coresh JJ, Heiss G, Wu KK, Boerwinkle E, Mosley TH, Sorlie P, Diao G
Secondary AuthorsSharrett ARichey
JournalArch Intern Med
Volume166
Issue13
Pagination1368-73
Date Published2006 Jul 10
ISSN0003-9926
Keywords1-Alkyl-2-acetylglycerophosphocholine Esterase, Age Factors, Aged, Antihypertensive Agents, Biomarkers, Blood Pressure, C-Reactive Protein, Cholesterol, Coronary Disease, Diabetes Mellitus, Female, Humans, Interleukin-6, Male, Middle Aged, Phospholipases A, Prospective Studies, Risk Assessment, Risk Factors, ROC Curve, Sex Factors, Smoking, Thrombomodulin, United States, Vitamin B 6
Abstract

BACKGROUND: There has been interest in recent years in whether additional, and in particular novel, risk factors or blood markers, such as C-reactive protein, can enhance existing coronary heart disease (CHD) prediction models.

METHODS: Using a series of case-cohort studies, the prospective Atherosclerosis Risk in Communities (ARIC) Study assessed the association of 19 novel risk markers with incident CHD in 15,792 adults followed up since 1987-1989. Novel markers included measures of inflammation, endothelial function, fibrin formation, fibrinolysis, B vitamins, and antibodies to infectious agents. Change in the area under the receiver operating characteristic curve (AUC) was used to assess the additional contribution of novel risk markers to CHD prediction beyond that of traditional risk factors.

RESULTS: The basic risk factor model, which included traditional risk factors (age, race, sex, total and high-density lipoprotein cholesterol levels, systolic blood pressure, antihypertensive medication use, smoking status, and diabetes), predicted CHD well, as evidenced by an AUC of approximately 0.8. The C-reactive protein level did not add significantly to the AUC (increase in AUC of 0.003), and neither did most other novel risk factors. Of the 19 markers studied, lipoprotein-associated phospholipase A(2), vitamin B(6), interleukin 6, and soluble thrombomodulin added the most to the AUC (range, 0.006-0.011).

CONCLUSIONS: Our findings suggest that routine measurement of these novel markers is not warranted for risk assessment. On the other hand, our findings reinforce the utility of major, modifiable risk factor assessment to identify individuals at risk for CHD for preventive action.

DOI10.1001/archinte.166.13.1368
Alternate JournalArch Intern Med
PubMed ID16832001
Grant ListN01-HC-55015 / HC / NHLBI NIH HHS / United States
N01-HC-55016 / HC / NHLBI NIH HHS / United States
N01-HC-55018 / HC / NHLBI NIH HHS / United States
N01-HC-55019 / HC / NHLBI NIH HHS / United States
N01-HC-55020 / HC / NHLBI NIH HHS / United States
N01-HC-55021 / HC / NHLBI NIH HHS / United States
N01-HC-55022 / HC / NHLBI NIH HHS / United States