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Biomarkers versus traditional risk factors to predict cardiovascular events in very old adults: cross-validated prospective cohort study.
Vaes, Bert; Indestege, Paulien; Serneels, Tinne; Hegendörfer, Eralda; van Peet, Petra G; Poortvliet, Rosalinde K E; Wallemacq, Pierre; Gussekloo, Jacobijn; Degryse, Jan.
Afiliación
  • Vaes B; Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium bert.vaes@kuleuven.be.
  • Indestege P; Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
  • Serneels T; Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
  • Hegendörfer E; Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
  • van Peet PG; Institute of Health and Society, Université catholique de Louvain (UCL), Brussels, Belgium.
  • Poortvliet RKE; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
  • Wallemacq P; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
  • Gussekloo J; Laboratory of Analytical Biochemistry, Cliniques Universitaires St Luc, Université catholique de Louvain (UCL), Brussels, Belgium.
  • Degryse J; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
BMJ Open ; 10(6): e035809, 2020 06 28.
Article en En | MEDLINE | ID: mdl-32595156
OBJECTIVES: To test new cardiovascular (CV) risk models in very old adults with and without a history of CV disease (CVD), based on traditional risk factors and biomarkers. DESIGN: Cross-validated prospective cohort study. The models were tested in the BELFRAIL Study and externally validated in the Leiden 85-plus Study. SETTING: General practice, Belgium and The Netherlands. PARTICIPANTS: The BELFRAIL cohort consisted of 266 patients aged 80 years or older without a history of CVD and 260 with a history of CVD. The Leiden 85-plus Study consisted of 264 patients aged 85 years without a history of CVD and 282 with a history of CVD. OUTCOME MEASURES: The model with traditional risk factors and biomarkers, as well as the model using only biomarkers, was compared with the model with only traditional risk factors to predict 3-year CV morbidity and mortality. A competing-risk analysis was performed, and the continuous net reclassification improvement (NRI), integrated discrimination improvement (IDI) and net benefit were used to compare the predictive value of the different models. RESULTS: Traditional risk factors poorly predicted CV mortality and morbidity. In participants without a history of CVD, adding N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) improved the prediction (NRI 0.56 (95% CI 0.16 to 0.99) and relative IDI 4.01 (95% CI 2.19 to 6.28)). In participants with a history of CVD, the NRI with the addition of NT-pro-BNP and high-sensitivity C reactive protein was 0.38 (95% CI 0.09 to 0.70), and the relative IDI was 0.53 (95% CI 0.23 to 0.90). Moreover, in participants without a history of CVD, NT-pro-BNP performed well as a stand-alone predictor (NRI 0.32 (95% CI -0.12 to 0.74) and relative IDI 3.44 (95% CI 1.56 to 6.09)). CONCLUSIONS: This study tested new risk models to predict CV morbidity and mortality in very old adults. Especially, NT-pro-BNP showed a strong added predictive value. This opens perspectives for clinicians who are in need of an easily applicable strategy for CV risk prediction in very old adults.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Biomarcadores / Factores de Riesgo de Enfermedad Cardiaca Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged80 / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: BMJ Open Año: 2020 Tipo del documento: Article País de afiliación: Bélgica Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Biomarcadores / Factores de Riesgo de Enfermedad Cardiaca Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged80 / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: BMJ Open Año: 2020 Tipo del documento: Article País de afiliación: Bélgica Pais de publicación: Reino Unido