Article

Evaluating New Cardiovascular Risk Factors for Risk Stratification

Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
Journal of Clinical Hypertension (Impact Factor: 2.85). 07/2008; 10(6):485-8. DOI: 10.1111/j.1751-7176.2008.07814.x
Source: PubMed

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    • "The predictive capacity of a marker in a population can be described using the population distribution of risk (Huang et al. 2007; Pepe et al. 2008a; Stern 2008). Virtually all standard statistical summaries of predictability and discrimination can be derived from it (Gail and Pfeiffer 2005). "
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    ABSTRACT: The predictive capacity of a marker in a population can be described using the population distribution of risk (Huang et al. 2007; Pepe et al. 2008a; Stern 2008). Virtually all standard statistical summaries of predictability and discrimination can be derived from it (Gail and Pfeiffer 2005). The goal of this paper is to develop methods for making inference about risk prediction markers using summary measures derived from the risk distribution. We describe some new clinically motivated summary measures and give new interpretations to some existing statistical measures. Methods for estimating these summary measures are described along with distribution theory that facilitates construction of confidence intervals from data. We show how markers and, more generally, how risk prediction models, can be compared using clinically relevant measures of predictability. The methods are illustrated by application to markers of lung function and nutritional status for predicting subsequent onset of major pulmonary infection in children suffering from cystic fibrosis. Simulation studies show that methods for inference are valid for use in practice.
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    ABSTRACT: Purpose: To review the clinical benefits of inhibiting the renin–angiotensin system (RAS) through blood pressure (BP)–lowering and BP-independent mechanisms and to identify the benefits and potential limitations of RAS-blocking agents in various patient populations.Data sources: PubMed search using the key terms renin-angiotensin system, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, aliskiren, heart failure, diabetes, and nephropathy. Current published guidelines from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, American Diabetes Association, and National Kidney Foundation were reviewed.Conclusion: Antihypertensive treatment with an agent that inhibits the RAS effectively lowers BP in a broad range of patients. Whether these agents improve clinical outcomes is the subject of ongoing investigation. Results of recent trials suggest that for patients with or at risk of high-risk conditions, such as heart failure or diabetes, risk reduction with RAS-blocking agents may be independent of BP reduction. Inhibition of the RAS may also reduce risk of renal impairment.Implications for practice: RAS-blocking agents are important in a variety of patient populations at high cardiovascular risk, but while angiotensin-converting enzyme inhibitors have proven benefits in some cases, angiotensin receptor blockers may be preferred in others. Direct renin inhibitors are currently being evaluated. The nurse practitioner should become familiar with the evidence for use of these agents to reduce risk and improve outcomes in specific populations.
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