title: Cardiac and kidney markers for cardiovascular prediction in individuals with chronic kidney disease: the Atherosclerosis Risk in Communities study.
abstract: OBJECTIVE
  Traditional predictors suboptimally predict cardiovascular disease (CVD) in individuals with chronic kidney disease (CKD). This study compared 5 nontraditional cardiac and kidney markers on the improvement of cardiovascular prediction among those with CKD.
  
  
  RESULTS
  Among 8622 participants aged 52 to 75 years in the Atherosclerosis Risk in Communities (ARIC) Study, cardiac troponin T, N-terminal pro-B-type natriuretic peptide, cystatin C, β2-microglobulin, and β-trace protein were compared for improvement in predicting incident CVD after stratifying by CKD status (940 participants with CKD [kidney dysfunction or albuminuria]). During a median follow-up of 11.9 years, there were 1672 CVD events including coronary disease, stroke, and heart failure (336 cases in CKD). Every marker was independently associated with incident CVD in participants with and without CKD. The adjusted hazard ratios (per 1 SD) were larger for cardiac markers than for kidney markers, particularly in CKD (1.61 [95% confidence interval, 1.43-1.81] for cardiac troponin T, 1.50 [1.34-1.68] for N-terminal pro-B-type natriuretic peptide, and <1.26 for kidney markers). Particularly in CKD group, cardiac markers compared with kidney markers contributed to greater c-statistic increment (0.032-0.036 versus 0.012-0.015 from 0.679 with only conventional predictors in CKD and 0.008-0.011 versus 0.002-0.010 from 0.697 in non-CKD) and categorical net reclassification improvement (0.086-0.127 versus 0.020-0.066 in CKD and 0.057-0.077 versus 0.014-0.048 in non-CKD). The superiority of cardiac markers was largely consistent in individual CVD outcomes.
  
  
  CONCLUSIONS
  A greater improvement in cardiovascular prediction was observed for cardiac markers than for kidney markers in people with CKD. These results suggest that cardiac troponin T and N-terminal pro-B-type natriuretic peptide are useful for better CVD risk classification in this population.
authors.affiliation: From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., Y.S., S.H.B., M.W., J.C.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); Department of Medicine, Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.). kmatsush@jhsph.edu.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.affiliation: From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., Y.S., S.H.B., M.W., J.C.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); Department of Medicine, Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Yingying
authors.initials: Y
authors.lastname: Sang
authors.affiliation: From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., Y.S., S.H.B., M.W., J.C.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); Department of Medicine, Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Shoshana H
authors.initials: SH
authors.lastname: Ballew
authors.affiliation: From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., Y.S., S.H.B., M.W., J.C.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); Department of Medicine, Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.affiliation: From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., Y.S., S.H.B., M.W., J.C.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); Department of Medicine, Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Ron C
authors.initials: RC
authors.lastname: Hoogeveen
authors.affiliation: From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., Y.S., S.H.B., M.W., J.C.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); Department of Medicine, Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.affiliation: From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., Y.S., S.H.B., M.W., J.C.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); Department of Medicine, Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., Y.S., S.H.B., M.W., J.C.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); Department of Medicine, Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.affiliation: From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., Y.S., S.H.B., M.W., J.C.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); Department of Medicine, Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (R.C.H., C.M.B.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.).
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D055316:Cystatin C / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D019746:Intramolecular Oxidoreductases / Q000097:blood; D054834:Lipocalins / Q000097:blood; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D020107:Troponin T / Q000097:blood; D014481:United States / Q000453:epidemiology; D001613:beta 2-Microglobulin / Q000097:blood
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D054834:Lipocalins; D010446:Peptide Fragments; D020107:Troponin T; D001613:beta 2-Microglobulin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D019746:Intramolecular Oxidoreductases; C022466:prostaglandin R2 D-isomerase
keywords: biological markers; cardiovascular diseases; risk assessment