Biomarker-based risk prediction in the community.
Guided by predictive characteristics of cardiovascular biomarkers, we explored the clinical implications of a simulated biomarker-guided heart failure (HF) and major adverse cardiovascular events (MACE) prevention strategy in the community.



In a community cohort (n = 1824), the predictive characteristics for HF and MACE of galectin-3 (Gal-3), ST2, high-sensitivity cardiac troponin I (hscTnI), high-sensitivity C-reactive protein (hsCRP), N-terminal pro-brain natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP) were established. We performed number needed to screen (NNS) and treat (NNT) with the intervention analyses according to biomarker screening strategy and intervention efficacy in persons with at least one cardiovascular risk factor. In the entire cohort, for both HF and MACE, the predictive characteristics of NT-proBNP and hscTnI were superior to other biomarkers; alone, in a multimarker model, and adjusting for clinical risk factors. An NT-proBNP-guided preventative intervention with an intervention effect size (4-year hazard ratio for intervention in biomarker positive cohort) of ≤0.7 would reduce the global burden of HF by ≥20% and MACE by ≥15%. From this simulation, the NNS to prevent one HF event or MACE in 4 years would be ≤100 with a NNT to prevent one HF event of ≤20 and one MACE of ≤10.



The predictive characteristics of NT-proBNP and hscTnI for HF or MACE in the community are superior to other biomarkers. Biomarker-guided preventative interventions with reasonable efficacy would compare favourably to established preventative interventions. This data provides a framework for biomarker selection which may inform design of biomarker-guided preventative intervention trials.
Cardiorenal Research Laboratory.|Department of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN, USA.
Omar F
OF
AbouEzzeddine
Cardiorenal Research Laboratory.|Department of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN, USA.
Paul M
PM
McKie
Division of Biomedical Statistics and Informatics, Mayo Clinic and Foundation, Rochester, MN, USA.
Christopher G
CG
Scott
Cardiorenal Research Laboratory.|Department of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN, USA.
Richard J
RJ
Rodeheffer
Cardiorenal Research Laboratory.|Department of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN, USA.
Horng H
HH
Chen
Department of Medicine, Duke University Medical Center, Durham, NC, USA.
G
G
Michael Felker
Department of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN, USA.|Department of Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, MN, USA.
Allan S
AS
Jaffe
Cardiorenal Research Laboratory.|Department of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN, USA.
John C
JC
Burnett
Cardiorenal Research Laboratory. redfield.margaret@mayo.edu.|Department of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN, USA. redfield.margaret@mayo.edu.
Margaret M
MM
Redfield
D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood / Q000453:epidemiology / Q000378:metabolism; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000378:metabolism / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D037502:Galectin 3 / Q000097:blood*; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology / Q000378:metabolism; D006801:Humans; D057187:Independent Living; D000072179:Interleukin-1 Receptor-Like 1 Protein / Q000097:blood*; D002546:Ischemic Attack, Transient / Q000097:blood / Q000453:epidemiology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology / Q000378:metabolism; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D016016:Proportional Hazards Models; D011655:Pulmonary Embolism / Q000097:blood / Q000453:epidemiology / Q000378:metabolism; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000453:epidemiology / Q000378:metabolism; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D037502:Galectin 3; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein
Biomarkers; Heart failure; Prevention