Study: Multimodal Test Is Better at Predicting CVD Risk Than Traditional Tests
A combination of 5 cardiovascular disease (CVD) risk assessment tests significantly improves global CVD and atherosclerotic CVD risk assessment in adults without known CVD, according to the findings of a recent study.1
The current methods for assessing CVD risk in adults are suboptimal, according to the researchers, because the methods are limited in focus and are based on traditional risk factors. For their study, the researchers sought to determine whether combining biomarkers with different testing modalities would improve global and atherosclerotic CVD risk assessment and prediction for all adults.
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The study included 6621 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) and 2202 participants from the Dallas Heart Study (DHS) who did not have CVD at baseline and underwent the following tests: measurement of left ventricular hypertrophy by electrocardiogram (ECG-LVH), coronary artery calcium (CAC), N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), and high-sensitivity C-reactive protein (hs-CRP).
Researchers assessed associations between the test results and global composite of CVD outcomes—including CVD death, myocardial infarction, and stroke—and atherosclerotic CVD outcomes--including fatal or nonfatal myocardial infarction or stroke—over more than 10 years of follow-up.
After analysis, the researchers found that the ECG-LVH, CAC, NT-proBNP, hs-cTnT, and hs-CRP test results were independently associated with global composite CVD events in participants involved with MESA.
In addition, a simple integer score that counted the number of abnormal test results showed that CVD risk increased with score. Compared with participants who had a score of 0, a score of 1 was associated with an adjusted hazard ratio (HR) of 1.9, a 2 was associated with an HR of 3.2, a 3 was associated with an HR of 4.7, and a 4 or more was associated with an HR of 7.5, for participants in MESA.
The analyses of DHS participants showed similar results and had similar atherosclerotic CVD outcomes.
“This set of tests is really powerful in identifying unexpected risk among individuals with few traditional risk factors,” the researchers noted. “These are people who would not be aware that they are at risk for heart disease and might not be targeted for preventive therapies.”2
—Melissa Weiss
Reference:
1. de Lemos JA, Ayers CR, Levine BD, et al. A multimodality strategy for cardiovascular risk assessment: performance in two population-based cohorts [published online March 30, 2017]. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.117.027272.
2. These 5 tests better predict heart disease risk [press release]. Dallas, TX: UT Southwestern Medical Center; March 30, 2017. http://www.utsouthwestern.edu/newsroom/news-releases/year-2017/mar/risk-assessment-khera.html