Dynamic Cardiovascular Risk Assessment in Elderly People

deFilippi, Christopher R.; Christenson, Robert H.; Gottdiener, John S.; Kop, Willem J.; Seliger, Stephen L.

doi:10.1016/j.jacc.2009.07.069

Cited by 112 publications

(94 citation statements)

References 34 publications

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“…The addition of sST2 to demographics and clinical risk factors only modestly improved discrimination and risk reclassification for incident HF and cardiovascular death. However, similar to other cohorts, increasing levels of ST2 in older adults in a cross‐sectional analysis were associated with higher risk demographics, increased comorbidities, and increasing levels of cardiac specific and noncardiac specific biomarkers that have been independently associated with poorer outcomes 18, 27, 28, 39…”

Section: Discussionsupporting

confidence: 74%

“…Participants (N=5201) initially enrolled in 1989–1990, and an black supplemental cohort (N=687) enrolled in 1992–1993. This ancillary analysis included participants without a previous diagnosis of HF in whom measures of amino terminal pro‐B‐type natriuretic peptide (NT‐proBNP) and high‐sensitivity cardiac troponin T (hs‐cTnT) had already been performed as previously described27, 28 and with available stored serum for measurement of sST2. Figure 1 is a flow diagram of CHS participants who met criteria or were excluded for the present sST2 analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Analyte stability has been demonstrated for at least 1.5 years from previously frozen samples 30. Details of NT‐proBNP, C‐reactive protein (CRP), and hs‐cTnT have been previously described in CHS 27, 28, 31…”

Section: Methodsmentioning

confidence: 99%

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Soluble ST2 for Prediction of Heart Failure and Cardiovascular Death in an Elderly, Community‐Dwelling Population

Parikh

Seliger

Christenson

et al. 2016

JAHA

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BackgroundSoluble ST2 (sST2), a marker of myocyte stretch and fibrosis, has prognostic value in many cardiovascular diseases. We hypothesized that sST2 levels are associated with incident heart failure (HF), including subtypes of preserved (HFpEF) and reduced (HFrEF) ejection fraction, and cardiovascular death.Methods and ResultsBaseline serum sST2 was measured in 3915 older, community‐dwelling subjects from the Cardiovascular Health Study without prevalent HF. sST2 levels were associated with older age, male sex, black race, traditional cardiovascular risk factors, other biomarkers of inflammation, cardiac stretch, myocardial injury, and fibrosis, and abnormal echocardiographic parameters. In longitudinal analysis, greater sST2 was associated with a higher risk of incident HF and cardiovascular death; however, in multivariate models adjusting for other cardiac risk factors and the cardiac‐specific biomarker, N‐terminal pro–type B natriuretic peptide, these associations were attenuated. In these models, an sST2 level above the US Food and Drug Administration–approved cut‐off value (>35 ng/mL) was significantly associated with incident HF (hazard ratio [HR], 1.20; 95% CI, 1.02–1.43) and cardiovascular death (HR, 1.21; 95% CI, 1.02–1.44), and greater sST2 was continuously associated with cardiovascular death (per 1‐ln increment: HR, 1.24; 95% CI, 1.02–1.50). sST2 was not associated with the HF subtypes of HFpEF and HFrEF in adjusted analysis. Addition of sST2 to existing risk models of HF and cardiovascular death modestly improved discrimination and reclassification into a higher risk.ConclusionsThe predictive value of sST2 for HF of all subtypes and cardiovascular death is modest in an elderly population despite strong cross‐sectional associations with risk factors and underlying cardiac pathology.

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Section: Discussionsupporting

confidence: 74%

Section: Methodsmentioning

confidence: 99%

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Soluble ST2 for Prediction of Heart Failure and Cardiovascular Death in an Elderly, Community‐Dwelling Population

Parikh

Seliger

Christenson

et al. 2016

JAHA

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“…DeFilippi et al [11 ]found that increased levels of NT-proBNP over time predicted a higher risk of new-onset HF and CV-related death, independent of traditional risk factors and abnormalities on ECG and echocardiography. Our findings in patients with stable CAD are similar to those of deFilippi et al [11] in that the prognostic value of NT-proBNP appeared to follow a threshold effect, whereby the greatest change in NT-proBNP had the most robust association with adverse clinical outcomes. We observed this threshold at a 5-year change in NT-proBNP levels of ≥223 pg/mL, which was similar to the threshold of ≥190 pg/mL found in the study by deFilippi et al [11].…”

Section: Discussionmentioning

confidence: 99%

“…In a cohort of community-dwelling adults, increases in NT-proBNP levels over the long-term were associated with adverse CV outcomes [10,11]. Currently, however, it is not known whether long-term changes in levels of NT-proBNP predict subsequent adverse CV outcomes among patients with stable CAD.…”

Section: Introductionmentioning

confidence: 99%

The Association of Five-Year Changes in the Levels of N-Terminal Fragment of the Prohormone Brain-Type Natriuretic Peptide (NT-proBNP) with Subsequent Heart Failure and Death in Patients with Stable Coronary Artery Disease: The Heart and Soul Study

Mishra

Judson²,

Christenson³

et al. 2017

Cardiology

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Background: The N-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) is a powerful predictor of adverse outcomes in patients with coronary artery disease (CAD). However, little is known regarding the prognostic significance of longitudinal changes in NT-proBNP levels. Methods: We evaluated the ability of 5-year changes in NT-proBNP levels to predict subsequent heart failure (HF) hospitalization or cardiovascular (CV) death in 635 participants with stable CAD enrolled in the Heart and Soul Study. Results: The median (IQR) 5-year change in NT-proBNP was 50 pg/mL (-5 to +222). During an average of 4.0 ± 1.4 years follow-up (i.e., 9 years from the baseline measurement), there were 67 events. Participants with 5-year changes in the highest quartile (≥ 223 pg/mL increase in NT-proBNP) had an almost 4-fold greater risk of subsequent HF or CV death than those in the lowest quartile of ≤-5 pg/mL (HR 3.8; 95% CI 2.0-7.3; p < 0.001). This association remained strong after adjustment for demographic variables, comorbidities, left ventricular mass index, systolic and diastolic function, and baseline and follow-up NT-proBNP levels (HR 3.9; 95% CI 1.1-13.4; p = 0.01). Conclusion: Changes in NT-proBNP levels at 5 years predict subsequent HF or CV death in patients with stable CAD, independent of other prognostic markers, including baseline and follow-up NT-proBNP levels. A stable NT-proBNP level predicts a low risk of subsequent events.

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Association of Serial Measures of Cardiac Troponin T Using a Sensitive Assay With Incident Heart Failure and Cardiovascular Mortality in Older Adults

deFilippi¹,

Lemos²,

Christenson³

et al. 2010

JAMA

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483

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ISK STRATIFICATION FOR HEART failure (HF) in older adults involves unique clinical challenges. Elderly individuals comprise the largest subgroup of patients hospitalized for HF, accounting for 80% of the more than 1.1 million US admissions per year. 1,2 Once diagnosed with HF, older patients respond less well to guideline-based therapy than their younger counterparts, are more likely to require readmission, and are at higher risk for death. 2-4 Furthermore, prediction models based on traditional cardiovascular risk factors are less adept at identifying cardiovascular risk in older adults compared with younger populations. 5 Blood-based biomarkers, including C-reactive protein (CRP), natriuretic peptides, and troponins, have been advocated as adjuncts to clinical risk factors to identify community-dwelling older patients at high risk for adverse cardiovascular outcomes, but studies examining the additive prognostic value of these markers have reported inconsistent results.

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Dynamic Cardiovascular Risk Assessment in Elderly People

Cited by 112 publications

References 34 publications

Soluble ST2 for Prediction of Heart Failure and Cardiovascular Death in an Elderly, Community‐Dwelling Population

Soluble ST2 for Prediction of Heart Failure and Cardiovascular Death in an Elderly, Community‐Dwelling Population

The Association of Five-Year Changes in the Levels of N-Terminal Fragment of the Prohormone Brain-Type Natriuretic Peptide (NT-proBNP) with Subsequent Heart Failure and Death in Patients with Stable Coronary Artery Disease: The Heart and Soul Study

Association of Serial Measures of Cardiac Troponin T Using a Sensitive Assay With Incident Heart Failure and Cardiovascular Mortality in Older Adults

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