Multiple biomarkers for the prediction of first major cardiovascular events and death
Multiple biomarkers for the prediction of first major cardiovascular events and death
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DOI：
10.1056/nejmoa055373
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发表时间：
2006-12-21
影响因子：
158.5
通讯作者：
Vasan, Ramachandran S.
中科院分区：
文献类型：
--
作者：
Wang, Thomas J.;Gona, Philimon;Vasan, Ramachandran S.
背景：很少有研究评估来自不同生物途径的多个生物标志物在预测心血管事件风险方面的增量有效性。方法：我们测量了参加Framingham心脏研究常规检查周期的3209名参与者的10个生物标志物：C反应蛋白、B型钠尿肽、N端心钠素前体、醛固酮、肾素、纤维蛋白原、d-二聚体、纤溶酶原激活物抑制物1和同型半胱氨酸的水平；以及尿白蛋白与肌酐的比率。结果：在中位数为7.4年的随访期间，207名参与者死亡，169人首次发生重大心血管事件。在对传统危险因素进行校正的COX比例风险模型中，下列生物标志物对死亡风险的预测最强(每个生物标志物紧随其后的是对数值每增加1个SD的调整后的危险比)：B型利钠肽水平(1.40)、C反应蛋白水平(1.39)、尿白蛋白/肌酐比率(1.22)、同型半胱氨酸水平(1.20)和肾素水平(1.17)。最能预测主要心血管事件的生物标志物是B型利钠肽水平(调整后的危险比，对数值每增加1个SD，增加1.25)和尿白蛋白/肌酐比率(1.20)。与得分最低的两个五分之一的人相比，得分最高的五分之一的人(基于重要生物标志的回归系数)死亡风险更高(调整后的危险比，4.08；P
BACKGROUND:Few investigations have evaluated the incremental usefulness of multiple biomarkers from distinct biologic pathways for predicting the risk of cardiovascular events.METHODS:We measured 10 biomarkers in 3209 participants attending a routine examination cycle of the Framingham Heart Study: the levels of C-reactive protein, B-type natriuretic peptide, N-terminal pro-atrial natriuretic peptide, aldosterone, renin, fibrinogen, d-dimer, plasminogen-activator inhibitor type 1, and homocysteine; and the urinary albumin-to-creatinine ratio.RESULTS:During follow-up (median, 7.4 years), 207 participants died and 169 had a first major cardiovascular event. In Cox proportional-hazards models adjusting for conventional risk factors, the following biomarkers most strongly predicted the risk of death (each biomarker is followed by the adjusted hazard ratio per 1 SD increment in the log values): B-type natriuretic peptide level (1.40), C-reactive protein level (1.39), the urinary albumin-to-creatinine ratio (1.22), homocysteine level (1.20), and renin level (1.17). The biomarkers that most strongly predicted major cardiovascular events were B-type natriuretic peptide level (adjusted hazard ratio, 1.25 per 1 SD increment in the log values) and the urinary albumin-to-creatinine ratio (1.20). Persons with ``multimarker'' scores (based on regression coefficients of significant biomarkers) in the highest quintile as compared with those with scores in the lowest two quintiles had elevated risks of death (adjusted hazard ratio, 4.08; P