Several clinically available cardiac biomarkers have established their prognostic
value in patients with acute coronary syndromes. However, their relative prognostic
significance in stable subjects has not been prospectively validated, either individually
or in combination. The aim of this study was to evaluate the extent to which B-type
natriuretic peptide, myeloperoxidase, and high-sensitivity C-reactive protein alone
or together could be prognostic biomarkers in 3,635 consecutive stable patients without
acute coronary syndrome who underwent elective diagnostic coronary angiography. After
adjusting for traditional risk factors and renal function, each of the markers monitored
was a significant predictor of incident major adverse cardiovascular events (death,
nonfatal myocardial infarction, and stroke) over 3 years. A cardiac biomarker score
based on the sum total of “positive” biomarkers provided independent prediction of
future risk for incident major adverse cardiovascular events at 3 years (hazard ratio
[HR] 7.61, 95% confidence interval [CI] 4.98 to 11.65, p <0.001), even after adjusted
for traditional risk factors (HR 6.11, 95% CI 3.98 to 9.38, p <0.001). A positive
cardiac biomarker score remained a strong and independent predictor of 3-year risk
for major adverse cardiovascular events among those with normal glycemic control (HR
4.24, 95% CI 1.96 to 9.18, p <0.001), those with prediabetes (HR 7.62, 95% CI 3.87
to 15.01, p <0.001), and those with diabetes (HR 5.61, 95% CI 2.55 to 12.33, p <0.001),
as well as within subjects without significant angiographic evidence of coronary artery
disease (HR 10.82, 95% CI 3.82 to 30.6, p <0.001). In conclusion, an integrated assessment
of cardiac biomarkers may provide independent prognostic value for long-term adverse
clinical events in stable cardiac patients.
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References
- Multimarker approach to risk stratification in non-ST elevation acute coronary syndromes: simultaneous assessment of troponin I, C-reactive protein, and B-type natriuretic peptide.Circulation. 2002; 105: 1760-1763
- The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes.N Engl J Med. 2001; 345: 1014-1021
- Prognostic value of myeloperoxidase in patients with chest pain.N Engl J Med. 2003; 349: 1595-1604
- C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women.N Engl J Med. 2000; 342: 836-843
- Future of biomarkers in acute coronary syndromes: moving toward a multimarker strategy.Circulation. 2003; 108: 250-252
- Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).JAMA. 2001; 285: 2486-2497
- Standards of medical care in diabetes—2012.Diabetes Care. 2012; 35: S11-S63
- Plasma myeloperoxidase predicts incident cardiovascular risks in stable patients undergoing medical management for coronary artery disease.Clin Chem. 2011; 57: 33-39
- Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein.N Engl J Med. 2008; 359: 2195-2207
- Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events.N Engl J Med. 2001; 344: 1959-1965
- Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events.N Engl J Med. 2002; 347: 1557-1565
- Usefulness of C-reactive protein and left ventricular diastolic performance for prognosis in patients with left ventricular systolic heart failure.Am J Cardiol. 2008; 101: 370-373
- C-reactive protein is a bystander of cardiovascular disease.Eur Heart J. 2010; 31: 2092-2096
- Genetic loci associated with C-reactive protein levels and risk of coronary heart disease.JAMA. 2009; 302: 37-48
- Formation of nitric oxide-derived oxidants by myeloperoxidase in monocytes: pathways for monocyte-mediated protein nitration and lipid peroxidation In vivo.Circ Res. 1999; 85: 950-958
- Leukocytes utilize myeloperoxidase-generated nitrating intermediates as physiological catalysts for the generation of biologically active oxidized lipids and sterols in serum.Biochemistry. 1999; 38: 16904-16915
- Serum myeloperoxidase levels independently predict endothelial dysfunction in humans.Circulation. 2004; 110: 1134-1139
- Myeloperoxidase and cardiovascular disease.Arterioscler Thromb Vasc Biol. 2005; 25: 1102-1111
- Myeloperoxidase, modified lipoproteins, and atherogenesis.J Lipid Res. 2009; 50: S346-S351
- Integrating plasma high-sensitivity C-reactive protein and myeloperoxidase for risk prediction in chronic systolic heart failure.Congest Heart Fail. 2011; 17: 105-109
- Risk prediction with serial myeloperoxidase monitoring in patients with acute chest pain.Clin Chem. 2011; 57: 1762-1770
- Use of myeloperoxidase for risk stratification in acute heart failure.Clin Chem. 2010; 56: 944-951
- Increased expression and plasma levels of myeloperoxidase are closely related to the presence of angiographically-detected complex lesion morphology in unstable angina.Heart. 2010; 96: 1716-1722
- B-type natriuretic peptide: a critical review.Congest Heart Fail. 2007; 13: 48-52
- Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure.J Am Coll Cardiol. 2007; 49: 1943-1950
- Prediabetes: a high-risk state for diabetes development.Lancet. 2012; 379: 2279-2290
Article info
Publication history
Published online: December 07, 2012
Accepted:
October 17,
2012
Received in revised form:
October 17,
2012
Received:
June 17,
2012
Footnotes
This research was supported in part by Grants P01HL087018-020001, P01HL076491-055328, 1R01HL103866, and 1RO1HL103931 from the National Institutes of Health, Bethesda, Maryland; Grant 1UL1RR024989 from the Cleveland Clinic Clinical Research Unit of the Case Western Reserve University CTSA, Cleveland, Ohio; and the LeDucq Foundation, Paris, France. Dr. Hazen is also supported in part by a gift from the Leonard Kreiger Fund, Cleveland, Ohio. Supplies and partial funding for performance of fasting lipid profiles, glucose, creatinine, apolipoprotein A1, apolipoprotein B, high-sensitivity C-reactive protein, myeloperoxidase, and B-type natriuretic peptide used in this study were provided by Abbott Laboratories, Inc., Abbott Park, Illinois.
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