Inflammatory biomarkers and the prediction of coronary events among people at intermediate risk: the EPIC-Norfolk prospective population study
ABSTRACT To evaluate the role of the inflammatory biomarkers C-reactive protein (CRP), myeloperoxidase, paraoxonase, secretory phospholipase A2 group IIA (sPLA2), lipoprotein-associated phospholipase A2, fibrinogen, macrophage chemoattractant protein-1 and adiponectin, in predicting the risk of coronary heart disease (CHD) among people estimated to be at intermediate risk according to the Framingham Risk Score (FRS).
Prospective case-control study nested in EPIC-Norfolk cohort.
Apparently healthy men and women aged 45-79 years.
Risk of future coronary artery disease.
For participants predicted to be at intermediate risk by the FRS, the highest c statistics were observed for FRS plus CRP (0.61, 95% CI 0.57 to 0.65) and for FRS plus sPLA2 (0.56, 95% CI 0.52 to 0.6). Net correct reclassification of cases and controls for each marker was assessed for people across the entire risk spectrum and again for people at intermediate risk only. The largest differences were observed for CRP, 12.0% net reclassification improvement in the entire risk spectrum and 28.4% net reclassification improvement in the intermediate-risk group and for sPLA2, the net reclassification improvement was 6.4% in the entire risk spectrum and 16.3% in the intermediate-risk group.
The discriminatory potential of inflammatory biomarkers was substantially different when analysed across the entire risk spectrum compared with the subgroup of people at intermediate risk.
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ABSTRACT: Atherosclerosis is a slow process that over time can lead to fatal events. Early identification and prediction of future risk can allow for preventive strategies to be instituted. There is an increasing interest in utilizing novel biomarkers in cardiovascular disease screening and management. These novel biomarkers may help in cardiovascular disease risk assessment and treatment monitoring, and some may be treatment targets. To be useful for risk prediction, novel biomarkers need to show a significant association with cardiovascular disease events and bring additional value in risk stratification when added to known risk prediction models. Biomarkers used for treatment monitoring need to show that they can serve as good surrogates of cardiovascular disease status. In this article, we present 3 biomarkers that are currently approved by the U.S. Food and Drug Administration for use in cardiovascular disease management and risk assessment: C-reactive protein, lipoprotein-associated phospholipase A2, and myeloperoxidase. Other new biomarkers have also been shown recently to help in cardiovascular disease risk prediction and management. In this article, we will review 2 of these new biomarkers: cardiac troponin T measured by a highly sensitive assay and brain natriuretic peptide.04/2012; 159(4):265-76. DOI:10.1016/j.trsl.2012.01.003
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ABSTRACT: Background & objectives: Secretory phospholipase A2 (sPLA2), a member of the phospholipase A2 superfamily of enzymes that hydrolyses phospholipids, is a potentially useful plasma biomarker for atherosclerotic cardiovascular disease. Cardiovascular diseases are the leading cause of mortality in women. The purpose of this study was to investigate the correlation between cardiovascular risk factors and the sPLA2 levels in women with metabolic syndrome as compared to women without metabolic syndrome and men with metabolic syndrome. Methods: Patients (n=100) with various cardiovascular risk factors consecutively evaluated at the Rehabilitation Hospital-Cardiology Department, Cluj-Napoca, Romania were enrolled during 2011, of whom 10 were excluded. The patients were divided in three groups: group 1 (37 women with metabolic syndrome), group 2 (27 men with metabolic syndrome), and group 3 (26 women without metabolic syndrome). Body weight, smoking habits, glycaemia, hypertension, and serum lipids fractions were analysed as cardiovascular factors. Serum sPLA2 activity was measured using the chromogenic method. Results: There were no statistically significant correlations between sPLA2 levels and the investigated risk factors, irrespective of patient groups. However, there were significant positive correlations between sPLA2 and hsCRP in all three groups (P<0.05). In women with no metabolic syndrome an negative correlation was found between sPLA2 levels and HDL-C- r=-0.419, P=0.03. In men with metabolic syndrome there was a direct correlation between sPLA2 levels and HOMA, r=0.43, P<0.05, 95% CI (-0.098; 1.15). Interpretation & conclusions: Women with metabolic syndrome did not display different sPLA2 levels as compared to men with metabolic syndrome and women without metabolic syndrome. However, women with metabolic syndrome demonstrated a low but positive correlation between sPLA2 and hsCRP levels.The Indian Journal of Medical Research 12/2013; 138(6):866-72. · 1.66 Impact Factor
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ABSTRACT: Background: Previous studies have reported an association between total and differential white blood cell (WBC) counts and incident coronary heart disease (CHD), but data from elderly populations are scarce. The purpose of this study was to examine the association between total and differential WBC counts and incident CHD in an elderly Japanese-American population. Methods: Total and differential WBC counts were examined at a baseline examination from 1991 to 1993 in the Honolulu Heart Program. Subjects were Japanese-American men aged 71-93 years free of CHD at baseline (N = 2879), who were divided into quartiles of total and differential WBC counts for analysis, and were followed for incident CHD for 8 years. Results: During the follow up period, 279 men developed CHD. Hazard ratio for incident CHD for each quartile of total and differential WBC counts were obtained by Cox regression using the lowest quartile as the reference group. After full adjustment including age, cardiovascular risk factors, chronic diseases and medication use, the hazard ratios in the highest quartiles of total WBC, granulocyte and neutrophil counts were 1.75 (95% confidence interval [CI], 1.18-2.62; P = 0.006), 1.66 (95%CI, 1.11-2.48; P = 0.01), and 1.57 (95%CI, 1.06-2.34; P = 0.03), respectively. No significant associations were found between lymphocyte or monocyte counts and incident CHD. Conclusions: Higher total WBC, granulocyte and neutrophil counts were associated with higher risk of incident CHD in a population of elderly Japanese-American men. Further studies are needed to establish cut-points and treatment options with anti-inflammatory medications. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.Atherosclerosis 12/2014; 238(2):153-158. DOI:10.1016/j.atherosclerosis.2014.12.003 · 3.97 Impact Factor