Age-Related Differences in the Contribution of Systolic Blood Pressure and Biomarkers to Cardiovascular Disease Risk Prediction: The Atherosclerosis Risk in Communities (ARIC) Study

Authors

Mahmoud Al Rifai
George E Taffet
Kunihiro Matsushita
Salim S Virani
James De Lemos
Amit Khera
Jarrett Berry
Chiadi Ndumele
David Aguilar
Caroline Sun
Ron C Hoogeveen
Elizabeth Selvin
Christie M Ballantyne
Vijay Nambi

Publication Date

10-1-2023

Journal

The American Journal of Cardiology

DOI

10.1016/j.amjcard.2023.07.118

PMID

37567021

PMCID

PMC10528351

PubMedCentral® Posted Date

10-1-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Humans, Cardiovascular Diseases, Blood Pressure, Biomarkers, Risk Factors, Atherosclerosis, Troponin T, Natriuretic Peptide, Brain, Peptide Fragments, Risk Assessment, systolic blood pressure, heart failure, cardiovascular disease, high-sensitivity troponin T, N-terminal pro-B-type natriuretic peptide, risk discrimination, risk reclassification

Abstract

We sought to determine how biomarkers known to be associated with hypertension-induced end-organ injury complement the use of systolic blood pressure (SBP) for cardiovascular disease (CVD) risk prediction at different ages. Using data from visits 2 (1990 to 1992) and 5 (2011 to 2013) of the Atherosclerosis Risk in Communities (ARIC) study, 3 models were used to predict CVD (composite of coronary heart disease, stroke, and heart failure). Model A included traditional risk factors (TRFs) except SBP, model B-TRF plus SBP, and model C-TRF plus biomarkers (high-sensitivity troponin T [hsTnT] and N-terminal pro-B-type natriuretic peptide [NT-proBNP]). Harrel's C-statistics were used to assess risk discrimination for CVD comparing models B and A and C and B. At visit 2, the addition of SBP to TRF (model B vs model A) significantly improved the C-statistic (∆C-statistic, 95% confidence interval 0.010, 0.007 to 0.013) whereas the addition of hsTnT to TRF (model C vs model B) decreased the C-statistic (∆C-statistic -0.0038, -0.0075 to -0.0001) compared with SBP. At visit 5, the addition of SBP to TRF did not significantly improve the C-statistic (∆C-statistic 0.001, -0.002 to 0.005) whereas the addition of both hsTnT and NT-proBNP to TRF significantly improved the C-statistic compared with SBP (∆C-statistic 0.028, 0.015 to 0.041 and 0.055, 0.036 to 0.074, respectively). In summary, the incremental value of SBP for CVD risk prediction diminishes with age whereas the incremental value of hsTnT and NT-proBNP increases with age.

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