Prognostic utility of novel biomarkers of cardiovascular stress: the Framingham Heart Study.
BACKGROUND
Biomarkers for predicting cardiovascular events in community-based populations have not consistently added information to standard risk factors. A limitation of many previously studied biomarkers is their lack of cardiovascular specificity.


RESULTS
To determine the prognostic value of 3 novel biomarkers induced by cardiovascular stress, we measured soluble ST2, growth differentiation factor-15, and high-sensitivity troponin I in 3428 participants (mean age, 59 years; 53% women) in the Framingham Heart Study. We performed multivariable-adjusted proportional hazards models to assess the individual and combined ability of the biomarkers to predict adverse outcomes. We also constructed a "multimarker" score composed of the 3 biomarkers in addition to B-type natriuretic peptide and high-sensitivity C-reactive protein. During a mean follow-up of 11.3 years, there were 488 deaths, 336 major cardiovascular events, 162 heart failure events, and 142 coronary events. In multivariable-adjusted models, the 3 new biomarkers were associated with each end point (P<0.001) except coronary events. Individuals with multimarker scores in the highest quartile had a 3-fold risk of death (adjusted hazard ratio, 3.2; 95% confidence interval, 2.2-4.7; P<0.001), 6-fold risk of heart failure (6.2; 95% confidence interval, 2.6-14.8; P<0.001), and 2-fold risk of cardiovascular events (1.9; 95% confidence interval, 1.3-2.7; P=0.001). Addition of the multimarker score to clinical variables led to significant increases in the c statistic (P=0.005 or lower) and net reclassification improvement (P=0.001 or lower).


CONCLUSIONS
Multiple biomarkers of cardiovascular stress are detectable in ambulatory individuals and add prognostic value to standard risk factors for predicting death, overall cardiovascular events, and heart failure.
Cardiology Division, GRB-800, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA. tjwang@partners.org
Thomas J
TJ
Wang
Kai C
KC
Wollert
Martin G
MG
Larson
Erin
E
Coglianese
Elizabeth L
EL
McCabe
Susan
S
Cheng
Jennifer E
JE
Ho
Michael G
MG
Fradley
Anahita
A
Ghorbani
Vanessa
V
Xanthakis
Tibor
T
Kempf
Emelia J
EJ
Benjamin
Daniel
D
Levy
Ramachandran S
RS
Vasan
James L
JL
Januzzi
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D005500:Follow-Up Studies; D055436:Growth Differentiation Factor 15 / Q000097:blood*; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D000072179:Interleukin-1 Receptor-Like 1 Protein; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011379:Prognosis; D016016:Proportional Hazards Models; D011956:Receptors, Cell Surface / Q000097:blood*; D012189:Retrospective Studies; D012307:Risk Factors; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D055436:Growth Differentiation Factor 15; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D011956:Receptors, Cell Surface; D019210:Troponin I; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein