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ARTICLE CONTRIBUTORS

Journal of the American Heart Association

Clinical Articles, Lead Article

Novel versus traditional risk factors in coronary heart disease

Novel risk factors are superior to traditional risk factors for predicting 5-year risk of secondary events in patients with stable coronary heart disease (CHD), according to the Heart and Soul Study, based at the University of California, San Francisco, published recently in the Journal of the American Heart Association.1

The authors sought to evaluate traditional and novel risk factors as predictors of secondary cardiovascular (CV) events, and to develop a prediction model that could be used to risk stratify patients with stable CHD. They used independent derivation (912 participants in the Heart and Soul Study) and validation (2,876 participants in the PEACE (Prevention of Events with Angiotensin-Converting Enzyme Inhibition) trial) cohorts of patients with stable CHD to develop a risk prediction model using Cox proportional hazards models.

The outcome was CV events, defined as myocardial infarction, stroke, or CV death. The annual rate of CV events was 3.4% in the derivation cohort and 2.2% in the validation cohort. With the exception of smoking, traditional risk factors (including age, sex, body mass index, hypertension, dyslipidaemia, and diabetes) did not emerge as the top predictors of secondary CV events.

Dr Alexis Beatty (University of Washington, USA)

Dr Alexis Beatty (University of Washington, USA)

The top four predictors of secondary events were the following: N-terminal pro-type brain natriuretic peptide, high-sensitivity cardiac troponin T, urinary albumin:creatinine ratio, and current smoking. The 5-year C-index for this 4-predictor model was 0.73 in the derivation cohort and 0.65 in the validation cohort.

As compared with variables in the Framingham secondary events model, the Heart and Soul risk model resulted in net re-classification improvement of 0.47 (95% CI 0.25 to 0.73) in the derivation cohort and 0.18 (95% CI 0.01 to 0.40) in the validation cohort. At this time, the authors have no plans to extend the study with longer follow-up.

Speaking to BJC Arrhythmia Watch, Dr Alexis Beatty (University of Washington, USA) said: β€œIn the current study, we demonstrate that novel biomarkers (and smoking) are superior to traditional risk factors for prediction of 5-year outcomes in stable ischaemic heart disease patients. This challenges the idea that we should rely on traditional risk factors alone to estimate risk in patients with stable ischaemic heart disease.”

β€œI think we need to further investigate whether using novel risk factors for risk stratification can influence patient outcomes. We hope that future studies will prospectively investigate a strategy of using novel risk factors for risk stratification, to guide treatment decisions in patients with stable ischaemic heart disease. We also continue to believe that smoking cessation is important,” Dr Beatty added.

References

1. Beatty AL, Ku IA, Bibbins-Domingo K, et al. Traditional risk factors versus biomarkers for prediction of secondary events in patients with stable coronary heart disease: from the Heart and Soul Study. J Am Heart Assoc 2015;4:e001646. http://dx.doi.org/10.1161/JAHA.114.001646

Published on: July 30, 2015

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