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Biomarker Measurement Has Mixed Predictive Value

Only modest value seen for postmenopausal CHD; may improve heart failure risk stratification in older adults

TUESDAY, May 4 (HealthDay News) -- Biomarker measurement may result in only modest improvement in coronary heart disease risk prediction in postmenopausal women, but inflammatory biomarkers are associated with heart failure risk in older adults, and measurement may improve heart failure risk stratification, according to two studies published in the May 11 issue of the Journal of the American College of Cardiology.

Hyeon Chang Kim, M.D., of Northwestern University in Chicago, and colleagues assessed the associations of traditional risk factors and 18 biomarkers in a nested case-control study of postmenopausal women who were enrolled in the Women's Health Initiative Hormone Trials: 321 patients with coronary heart disease and 743 controls. They found that traditional risk factors accounted for the majority of risk prediction content, and that the 18 biomarkers -- evaluated individually and in multi-marker predictive models -- only moderately improved risk prediction.

Andreas Kalogeropoulos, M.D., of Emory University in Atlanta, and colleagues assessed the association of baseline serum concentrations of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) with incident heart failure in 2,610 older adults, 311 of whom developed heart failure during a median follow-up of 9.4 years. They found that doubling of concentrations of IL-6, TNF-α, and CRP were associated with increased heart failure risks of 29 (P < 0.001), 46 (P < 0.001), and 9 percent (P = 0.087), respectively. However, in models including all three markers, they found that only elevated IL-6 and TNF-α remained significant.

"Rather than risk factors and biomarkers, which seem unlikely to ever achieve the diagnostic precision to be useful in individualized patient management, emphasis probably should be placed on more precise early diagnosis of the functional and structural disease likely to progress," writes the author of an editorial accompanying the second study.

A co-author of the first study disclosed financial ties to several pharmaceutical companies.

Abstract - Kim
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Abstract - Kalogeropoulos
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