TOPIC SERIES: CVD PREVENTION IN RHEUMATIC DISEASE

HealthDay News – New research published in the Journal of the American Medical Association the suggests that in patients with stable coronary heart disease (CHD), a risk score including 9 proteins outperformed the refit Framingham secondary event risk score.1  The 9-protein risk score was deemed to have modest discriminative accuracy.  

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Peter Ganz, MD., from the University of California, San Francisco, and colleagues conducted a prospective cohort study involving patients with stable CHD. They derived and validated a nine-protein risk score for four-year probability of myocardial infarction, stroke, heart failure, and all-cause death in a derivation cohort that included 938 samples and a validation cohort with 971 samples. The risk score was compared with the Framingham secondary event model, refit to the cohorts in this study.

High Yield Data Summary

  • The novel 9-protein risk score outperformed the refit Framingham secondary event risk score, with a noted modest discriminatory accuracy (C statistic of 0.70 as compared to 0.64 for the clinical score)

The researchers found that the C statistics were 0.66, 0.74, and 0.75 for refit Framingham, nine-protein, and refit Framingham plus nine-protein models, respectively, in the discrimination cohort. The corresponding C statistics were 0.64, 0.70, and 0.71, in the validation cohort. 

Adding the nine-protein risk score to the refit Framingham correlated with a 0.09 and 0.05 increase in the C statistic in the derivation and validation cohorts, respectively. The integrated discrimination index for the nine-protein model compared with the refit Framingham model was 0.12 and 0.08 in the derivation and validation cohorts, respectively.

Limitations and Disclosures

Applicability of this new risk score has not been determined for patients with lower risk for CHD.

“Further research is needed to assess whether the score is more accurate in a lower-risk population,” the authors write.

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Several authors disclosed financial ties to SomaLogic, which provided funding for and execution of the protein assays.

References

  1. Ganz P, Heidecker B, Hveem K, et al. Development and validation of a protein-based risk score for cardiovascular outcomes among patients with stable coronary heart disease. JAMA. 2016;315(23):2532-2541. doi: 10.1001/jama.2016.5951.
  2. Sabatine MS. Using aptamer-based technology to probe the plasma proteome for cardiovascular disease prediction. JAMA. 2016;315(23):2525-2526. doi: 10.1001/jama.2016.6110.