title: Incremental effects of endocrine and metabolic biomarkers and abdominal obesity on cardiovascular mortality prediction.
abstract: BACKGROUND
  Biomarkers may help clinicians predict cardiovascular risk. We aimed to determine if the addition of endocrine, metabolic, and obesity-associated biomarkers to conventional risk factors improves the prediction of cardiovascular and all-cause mortality.
  
  
  RESULTS
  In a population-based cohort study (the Study of Health in Pomerania) of 3,967 subjects (age 20-80 years) free of cardiovascular disease with a median follow-up of 10.0 years (38,638 person-years), we assessed the predictive value of conventional cardiovascular risk factors and the biomarkers thyrotropin; testosterone (in men only); insulin-like growth factor-1 (IGF-1); hemoglobin A1c (HbA1c); creatinine; high-sensitive C-reactive protein (hsCRP); fibrinogen; urinary albumin-to-creatinine ratio; and waist-to-height ratio (WHtR) on cardiovascular and all-cause death. During follow-up, we observed 339 all-cause including 103 cardiovascular deaths. In Cox regression models with conventional risk factors, the following biomarkers were retained as significant predictors of cardiovascular death after backward elimination: HbA1c, IGF-1, and hsCRP. IGF-1 and hsCRP were retained as significant predictors of all-cause death. For cardiovascular death, adding these biomarkers to the conventional risk factors changed the C-statistic from 0.898 to 0.910 (p = 0.02). The net reclassification improvement was 10.6%. For all-cause death, the C-statistic changed from 0.849 to 0.853 (P = 0.09).
  
  
  CONCLUSIONS
  HbA1c, IGF-1, and hsCRP predict cardiovascular death independently of conventional cardiovascular risk factors. These easily assessed endocrine and metabolic biomarkers might improve the ability to predict cardiovascular death.
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine, Ernst Moritz Arndt University Greifswald, Greifswald, Germany. harald.schneider@med.uni-muenchen.de
authors.forename: Harald Jörn
authors.initials: HJ
authors.lastname: Schneider
authors.forename: Henri
authors.initials: H
authors.lastname: Wallaschofski
authors.forename: Henry
authors.initials: H
authors.lastname: Völzke
authors.forename: Marcello Ricardo Paulista
authors.initials: MR
authors.lastname: Markus
authors.forename: Marcus
authors.initials: M
authors.lastname: Doerr
authors.forename: Stephan B
authors.initials: SB
authors.lastname: Felix
authors.forename: Matthias
authors.initials: M
authors.lastname: Nauck
authors.forename: Nele
authors.initials: N
authors.lastname: Friedrich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000209:etiology / Q000378:metabolism / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000150:complications*; D016016:Proportional Hazards Models; D012307:Risk Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; D007334:Insulin-Like Growth Factor I; C517652:hemoglobin A1c protein, human