Age-Related Differences in the Contribution of Systolic Blood Pressure and Biomarkers to Cardiovascular Disease Risk Prediction: The Atherosclerosis Risk in Communities (ARIC) Study

We sought to determine how biomarkers known to be associated with hypertension-induced end-organ injury complement the use of systolic blood pressure (SBP) for cardiovascular disease (CVD) risk prediction at different ages. Using data from visits 2 (1990 to 1992) and 5 (2011 to 2013) of the Atherosc...

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Vydáno v:	The American journal of cardiology Ročník 204; s. 295 - 301
Hlavní autoři:	Al Rifai, Mahmoud, Taffet, George E., Matsushita, Kunihiro, Virani, Salim S., De Lemos, James, Khera, Amit, Berry, Jarrett, Ndumele, Chiadi, Aguilar, David, Sun, Caroline, Hoogeveen, Ron C., Selvin, Elizabeth, Ballantyne, Christie M., Nambi, Vijay
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Elsevier Inc 01.10.2023 Elsevier Limited
Témata:	Age Antihypertensives Arteriosclerosis Atherosclerosis Atherosclerosis - epidemiology Biomarkers Blood Pressure Body mass index Brain natriuretic peptide Cardiovascular disease Cardiovascular diseases Cardiovascular Diseases - epidemiology Cholesterol Codes Confidence intervals Congestive heart failure Coronary artery disease Diabetes Gender Glucose Heart diseases heart failure high-sensitivity troponin T Hospitalization Humans Hypertension Immunoassay N-terminal pro-B-type natriuretic peptide Natriuretic Peptide, Brain Peptide Fragments Predictions Risk Assessment risk discrimination Risk Factors risk reclassification Smoking Statistical analysis Stroke systolic blood pressure Troponin Troponin T United States > US Minnesota Indianapolis Indiana cardiovascular disease heart failure risk reclassification high-sensitivity troponin T N-terminal pro-B-type natriuretic peptide systolic blood pressure risk discrimination
ISSN:	0002-9149, 1879-1913, 1879-1913
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Shrnutí:	We sought to determine how biomarkers known to be associated with hypertension-induced end-organ injury complement the use of systolic blood pressure (SBP) for cardiovascular disease (CVD) risk prediction at different ages. Using data from visits 2 (1990 to 1992) and 5 (2011 to 2013) of the Atherosclerosis Risk in Communities (ARIC) study, 3 models were used to predict CVD (composite of coronary heart disease, stroke, and heart failure). Model A included traditional risk factors (TRFs) except SBP, model B—TRF plus SBP, and model C—TRF plus biomarkers (high-sensitivity troponin T [hsTnT] and N-terminal pro-B-type natriuretic peptide [NT-proBNP]). Harrel's C-statistics were used to assess risk discrimination for CVD comparing models B and A and C and B. At visit 2, the addition of SBP to TRF (model B vs model A) significantly improved the C-statistic (∆C-statistic, 95% confidence interval 0.010, 0.007 to 0.013) whereas the addition of hsTnT to TRF (model C vs model B) decreased the C-statistic (∆C-statistic −0.0038, −0.0075 to −0.0001) compared with SBP. At visit 5, the addition of SBP to TRF did not significantly improve the C-statistic (∆C-statistic 0.001, −0.002 to 0.005) whereas the addition of both hsTnT and NT-proBNP to TRF significantly improved the C-statistic compared with SBP (∆C-statistic 0.028, 0.015 to 0.041 and 0.055, 0.036 to 0.074, respectively). In summary, the incremental value of SBP for CVD risk prediction diminishes with age whereas the incremental value of hsTnT and NT-proBNP increases with age.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 All authors (GET, KM, SSV, JDL, AK, JB, CN, DA, CS, RCH, ES, CMB) discussed the results and contributed to the final manuscript. MAR performed the statistical analysis and initial drafting of the manuscript. MAR and VN conceived the presented idea. AUTHORS’ CONTRIBUTIONS VN supervised the findings of this work.
ISSN:	0002-9149 1879-1913 1879-1913
DOI:	10.1016/j.amjcard.2023.07.118