Biomarkers offer refined HF risk prediction
MedWire News: B-type natriuretic peptide (BNP) and the urinary albumin-to-creatinine ratio (UACR) are important risk factors for the development of heart failure (HF), new research suggests.
The study investigators say that these biomarkers offer incremental predictive value over that of standard clinical risk factors; further, this finding "is consistent with the notion that activation of the natriuretic peptide system and the presence of endothelial dysfunction antedate and predict HF."
Several biological pathways have been individually implicated in left ventricular remodeling and/or HF but it is unclear whether biomarkers reflecting these pathways aid in the prediction and stratification of HF risk beyond standard risk factors.
In this study, Ramachandran Vasan (Framingham Heart Study, Massachusetts) and colleagues tested the predictive utility of a multibiomarker panel among 2754 participants in the Framingham Heart Study. Six biomarkers were measured: C-reactive protein, plasminogen activator inhibitor-1, homocysteine, aldosterone-to-renin ratio, BNP, and UACR.
The subjects' mean age was 58 years, 54% were women, and all were free of HF at baseline. The mean follow-up duration was 9.4 years, during which time there were 95 new HF diagnoses.
After adjusting for conventional risk factors, BNP and UACR emerged as significant predictors for HF risk, with hazard ratios of 1.52 and 1.35 per 1-standard deviation increment in log value, respectively.
Indeed, when these two markers were combined in a new "biomarker score", there was a "striking" 10-fold fold increase in HF incidence across tertiles, report Vasan et al in the journal Circulation.
Adding the biomarker score to a standard risk-prediction model improved the c-statistic from 0.84 to 0.86, a statistically significant, albeit modest, improvement.
Finally, the predictive ability of biomarkers was maintained in subgroups of participants with normal left ventricular function, those with renal function, and those without intervening ischemic events.
The researchers conclude: "We identified BNP and UACR as key biomarkers associated with HF risk… Additional investigations are warranted both to replicate our findings and to assess their applicability to routine clinical settings."
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By Joanna Lyford