Cardiovascular Biomarkers and Heart Failure Risk in Stable Patients With Atherothrombotic Disease: A Nested Biomarker Study From TRA 2°P‐TIMI 50
Background Patients with stable atherothrombotic disease vary in their risk of developing heart failure (HF). Circulating cardiovascular biomarkers may improve HF risk assessment and identify patients who may benefit from emerging HF preventive therapies. Methods and Results We measured high‐sensiti...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.018673 |
| _version_ | 1811333627140636672 |
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| author | David D. Berg Benjamin L. Freedman Marc P. Bonaca Petr Jarolim Benjamin M. Scirica Erica L. Goodrich Marc S. Sabatine David A. Morrow |
| author_facet | David D. Berg Benjamin L. Freedman Marc P. Bonaca Petr Jarolim Benjamin M. Scirica Erica L. Goodrich Marc S. Sabatine David A. Morrow |
| author_sort | David D. Berg |
| collection | DOAJ |
| description | Background Patients with stable atherothrombotic disease vary in their risk of developing heart failure (HF). Circulating cardiovascular biomarkers may improve HF risk assessment and identify patients who may benefit from emerging HF preventive therapies. Methods and Results We measured high‐sensitivity cardiac troponin I and BNP (B‐type natriuretic peptide) in 15 833 patients with prior myocardial infarction, ischemic stroke, or peripheral artery disease from the TRA 2°P‐TIMI 50 (Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events‐Thrombolysis in Myocardial Infarction 50) trial, excluding patients with recent myocardial infarction (<30 days). Biomarkers were categorized using a priori cut points. Hospitalization for HF (HHF) end points were adjudicated with blinded structured review of serious adverse events. Associations between biomarkers and HHF outcomes were adjusted for sex and independent clinical risk predictors of HHF in our cohort (age ≥75, prior HF, type 2 diabetes mellitus, polyvascular disease, body mass index, anemia, chronic kidney disease, hypertension). Baseline high‐sensitivity cardiac troponin I and BNP each identified a significant graded risk of HHF independent of clinical risk predictors, including in the subgroups of patients with and without type 2 diabetes mellitus and with and without prior HF. Patients with both high‐sensitivity cardiac troponin I ≥5 ng/L and BNP ≥100 pg/mL had the highest HHF event rates. When added to a multivariable Cox regression model with clinical risk predictors (C‐index 0.88; 95% CI, 0.85–0.90), BNP (C ‐index 0.92; 95% CI, 0.90–0.93), and high‐sensitivity cardiac troponin I (C‐index 0.90; 95% CI, 0.88–0.92) each significantly improved the prognostic performance of the model (both PLRT<0.001). Conclusions Biomarkers of myocardial injury and hemodynamic stress are independent predictors of HHF risk in patients with stable atherothrombotic disease, with and without prior HF and/or type 2 diabetes mellitus. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00526474. |
| first_indexed | 2024-04-13T16:55:48Z |
| format | Article |
| id | doaj.art-6e3d75915fc5499bb2bf69f456300b41 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:55:48Z |
| publishDate | 2021-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-6e3d75915fc5499bb2bf69f456300b412022-12-22T02:38:48ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-05-0110910.1161/JAHA.120.018673Cardiovascular Biomarkers and Heart Failure Risk in Stable Patients With Atherothrombotic Disease: A Nested Biomarker Study From TRA 2°P‐TIMI 50David D. Berg0Benjamin L. Freedman1Marc P. Bonaca2Petr Jarolim3Benjamin M. Scirica4Erica L. Goodrich5Marc S. Sabatine6David A. Morrow7TIMI Study Group Brigham and Women's HospitalHarvard Medical School Boston MADepartment of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MACPC Clinical Research University of Colorado School of Medicine Aurora CODepartment of Pathology Brigham and Women's HospitalHarvard Medical School Boston MATIMI Study Group Brigham and Women's HospitalHarvard Medical School Boston MATIMI Study Group Brigham and Women's HospitalHarvard Medical School Boston MATIMI Study Group Brigham and Women's HospitalHarvard Medical School Boston MATIMI Study Group Brigham and Women's HospitalHarvard Medical School Boston MABackground Patients with stable atherothrombotic disease vary in their risk of developing heart failure (HF). Circulating cardiovascular biomarkers may improve HF risk assessment and identify patients who may benefit from emerging HF preventive therapies. Methods and Results We measured high‐sensitivity cardiac troponin I and BNP (B‐type natriuretic peptide) in 15 833 patients with prior myocardial infarction, ischemic stroke, or peripheral artery disease from the TRA 2°P‐TIMI 50 (Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events‐Thrombolysis in Myocardial Infarction 50) trial, excluding patients with recent myocardial infarction (<30 days). Biomarkers were categorized using a priori cut points. Hospitalization for HF (HHF) end points were adjudicated with blinded structured review of serious adverse events. Associations between biomarkers and HHF outcomes were adjusted for sex and independent clinical risk predictors of HHF in our cohort (age ≥75, prior HF, type 2 diabetes mellitus, polyvascular disease, body mass index, anemia, chronic kidney disease, hypertension). Baseline high‐sensitivity cardiac troponin I and BNP each identified a significant graded risk of HHF independent of clinical risk predictors, including in the subgroups of patients with and without type 2 diabetes mellitus and with and without prior HF. Patients with both high‐sensitivity cardiac troponin I ≥5 ng/L and BNP ≥100 pg/mL had the highest HHF event rates. When added to a multivariable Cox regression model with clinical risk predictors (C‐index 0.88; 95% CI, 0.85–0.90), BNP (C ‐index 0.92; 95% CI, 0.90–0.93), and high‐sensitivity cardiac troponin I (C‐index 0.90; 95% CI, 0.88–0.92) each significantly improved the prognostic performance of the model (both PLRT<0.001). Conclusions Biomarkers of myocardial injury and hemodynamic stress are independent predictors of HHF risk in patients with stable atherothrombotic disease, with and without prior HF and/or type 2 diabetes mellitus. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00526474.https://www.ahajournals.org/doi/10.1161/JAHA.120.018673atherosclerosisbiomarkersheart failure |
| spellingShingle | David D. Berg Benjamin L. Freedman Marc P. Bonaca Petr Jarolim Benjamin M. Scirica Erica L. Goodrich Marc S. Sabatine David A. Morrow Cardiovascular Biomarkers and Heart Failure Risk in Stable Patients With Atherothrombotic Disease: A Nested Biomarker Study From TRA 2°P‐TIMI 50 Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atherosclerosis biomarkers heart failure |
| title | Cardiovascular Biomarkers and Heart Failure Risk in Stable Patients With Atherothrombotic Disease: A Nested Biomarker Study From TRA 2°P‐TIMI 50 |
| title_full | Cardiovascular Biomarkers and Heart Failure Risk in Stable Patients With Atherothrombotic Disease: A Nested Biomarker Study From TRA 2°P‐TIMI 50 |
| title_fullStr | Cardiovascular Biomarkers and Heart Failure Risk in Stable Patients With Atherothrombotic Disease: A Nested Biomarker Study From TRA 2°P‐TIMI 50 |
| title_full_unstemmed | Cardiovascular Biomarkers and Heart Failure Risk in Stable Patients With Atherothrombotic Disease: A Nested Biomarker Study From TRA 2°P‐TIMI 50 |
| title_short | Cardiovascular Biomarkers and Heart Failure Risk in Stable Patients With Atherothrombotic Disease: A Nested Biomarker Study From TRA 2°P‐TIMI 50 |
| title_sort | cardiovascular biomarkers and heart failure risk in stable patients with atherothrombotic disease a nested biomarker study from tra 2°p timi 50 |
| topic | atherosclerosis biomarkers heart failure |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.018673 |
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