Use of Novel Markers for the Prediction of Cardiovascular Disease: Updates from the Multi-Ethnic Study of Atherosclerosi
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ELDERLY AND HEART DISEASE (J WEI AND G AZHAR, SECTION EDITORS)
Use of Novel Markers for the Prediction of Cardiovascular Disease: Updates from the Multi-Ethnic Study of Atherosclerosis (MESA) Michael G. Silverman & Michael J. Blaha & Roger S. Blumenthal
Published online: 4 October 2013 # Springer Science+Business Media New York 2013
Abstract The development of technology has led to evolution in the risk assessment for cardiovascular disease (CVD). Current preventive guidelines for CVD recommend that management decisions should be based on risk assessment, which prototypically involves calculation of estimated risk using tools such as the Framingham risk score. This review will discuss some improved methods of risk stratification for CVD including the use of novel risk markers studied in the MultiEthnic Study of Atherosclerosis (MESA). Compared to several novel serum biomarkers, coronary artery calcium (CAC) offered a significantly higher improvement in discrimination and reclassification over both Framingham risk score and Reynolds risk score for individuals identified as having intermediate risk for CVD. Keywords Cardiovascular disease . Coronary heart disease . Prevention . Risk stratification . Biomarkers
Introduction Current cardiovascular disease (CVD) prevention guidelines recommend that management decisions should be based on risk assessment, which prototypically involves calculation of estimated risk using tools such as the Framingham risk score (FRS) [1]. Although risk stratification tools have proven to be M. G. Silverman : M. J. Blaha : R. S. Blumenthal (*) Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA e-mail: [email protected] M. G. Silverman e-mail: [email protected] M. J. Blaha e-mail: [email protected]
useful, there are still many individuals who are not identified as high risk prior to their first CVD event [2]. This has led many to search for improved methods of risk stratification including the use of novel risk markers. The Multi-Ethnic Study of Atherosclerosis (MESA), has provided important information regarding the utility of several novel markers in a multi-ethnic cohort free of baseline CVD. Key strengths of the MESA cohort have been the inclusion of White, Black, Chinese, and Hispanic men and women from six different centers in the US (Baltimore; Chicago; Forsyth County, North Carolina; Los Angeles; New York City; and St. Paul, Minnesota), as well as robust risk factor data collection including novel serologic and imaging markers; 6814 individuals were enrolled between 2000 and 2002. Information about CVD risk factors was collected by staff at each of the six centers including medical history, cigarette smoking, blood pressure measurements, anthropometric measurements, and laboratory data [3]. In this review we discuss recent papers from MESA evaluating the predictive ability of individual markers as well as those comparing novel risk markers for the improvement in risk prediction. An i
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