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Multiple Biomarker Panels for Cardiovascular Risk Assessment
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Multiple Biomarker Panels for Cardiovascular Risk Assessment
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Massachusetts, USA
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Massachusetts, USA
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Concept of cardiovascular “risk factors”
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Not all individuals with coronary heart disease have traditional risk factors
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CRP and cardiovascular risk in apparently healthy men
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CRP: epidemiologic studies
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Recommending wider use of CRP
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CRP: reappraisal
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What is the magnitude of association?
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The number of candidate cardiovascular biomarkers has increased
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There are other biomarkers: example
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BNP levels and Events over 5-year follow-up
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Risks associated with elevated BNP levels
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“Multimarker” approach
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Testing the multimarker approach: the Framingham Heart Study experience
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“Multimarker” approach
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Markers Selected by Backward Elimination
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Multiple biomarkers and ROC curves for CVD prediction
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Multiple markers and c-statistics in Framingham
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C-statistics (discrimination) versus relative risk
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Criticisms of the c-statistic and alternatives
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Reclassification: focus on specific cutpoints
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Reclassification to change therapy for primary prevention
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Reclassification matrix
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Measuring reclassification
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Slide 28
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Biomarkers for risk prediction in Malmo cohort: relative risks
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Reclassification matrix
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Reclassification matrix: cases only
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Reclassification matrix: Non-cases
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Reclassification in Malmo cohort
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Reclassification matrix: intermediate-risk only
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Reclassification matrix: cases only
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Reclassification matrix: Non-cases
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Reclassification in the intermediate-risk group
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What about the
JUPITER trial?
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JUPITER trial
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JUPITER trial myths
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Mendelian randomization data show no relation between CRP-altering SNPs and CV disease
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JUPITER trial myths
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JUPITER trial myths
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Implications of JUPITER (1)
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Implications of JUPITER (2)
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Clinical approaches
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CRP and re-classification using the Reynolds risk score
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What is the future of biomarkers for CV risk prediction?
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What is the gain from searching for more biomarkers?
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Most current biomarkers correlate with each other
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The search for novel biomarkers
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Proteomics and metabolomics
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Example: metabolomics and CAD
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Example: metabolomics and CAD
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Example: metabolomics and CAD
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Future directions
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