Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, University of Gothenburg, Diagnosvägen 11, 41650, Gothenburg, Sweden.
Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
BMC Cardiovasc Disord. 2021 Feb 2;21(1):65. doi: 10.1186/s12872-021-01886-x.
Ischaemic heart disease (IHD) often develops after decades of preceding subclinical coronary atherosclerosis. Biomarkers are useful prognostic predictors of IHD, but their long-term predictive value in a general population has not been adequately studied.
To investigate the early predictive value of multi-modality biomarkers in addition to clinical risk factors in incident IHD in a random male general population sample followed from 50 to 71 years of age.
"The Study of Men Born in 1943" is a longitudinal cohort study during follow-up. All the men underwent a baseline examination in 1993, where a panel of biomarkers were analysed and incident IHD was registered during 21-year follow-ups.
Of 739 participants, 97 men (13.1%) developed an IHD event. For time to first occurrence of IHD, univariable analyses showed that elevated levels of high sensitivity troponin T (hs-TNT), high sensitivity-C reactive protein (hs-CRP) and interleukin-6 (IL-6) were significant predictors of IHD. In addition, a high number of biomarkers with elevated levels (hs-TNT > 10 ng/L, hs-CRP > 1 mg/L, IL-6 > 8 ng/L and N-terminal pro b-type natriuretic peptide (NT-proBNP) > 100 pg/mL) increased predictive ability. In univariable and multivariable analysis high-density lipoprotein-cholesterol (HDL-C) had the highest predictive ability. Hs-TNT provided better predictive ability than smoking, body mass index and glucose, and was an independent significant predictor when adjusted for HDL-C, total cholesterol and hypertension. Addition of biomarkers on top of clinical risk factors provided significantly better prediction as tested by likelihood ratio test (p = 0.033), but did not significantly enhance the model's discriminative ability However, it appeared contributing to higher sensitivity in the late phase of follow-up.
In this random, middle-aged male population sample, the addition of biomarker hs-TNT was an independent significant predictor of IHD and significantly improved prediction, indicating the probability of a better prediction of long-term risk of IHD in a low-risk population.
The study is registered at Clinical Trials.gov Identifier number: NCT03138122.
缺血性心脏病（IHD）通常在数十年的亚临床冠状动脉粥样硬化后发展。生物标志物是 IHD 的有用预后预测指标，但它们在一般人群中的长期预测价值尚未得到充分研究。
在一个从 50 岁到 71 岁的随机男性普通人群样本中，研究除临床危险因素外，多模态生物标志物对 IHD 事件的早期预测价值。
“1943 年出生男性研究”是一项纵向队列研究，在随访期间进行。所有男性在 1993 年接受基线检查，分析了一组生物标志物，并在 21 年的随访中登记了 IHD 事件。
在 739 名参与者中，97 名男性（13.1%）发生了 IHD 事件。对于首次发生 IHD 的时间，单变量分析显示，高敏肌钙蛋白 T（hs-TNT）、高敏 C 反应蛋白（hs-CRP）和白细胞介素-6（IL-6）水平升高是 IHD 的显著预测指标。此外，高水平生物标志物数量的增加（hs-TNT>10ng/L、hs-CRP>1mg/L、IL-6>8ng/L 和 N 端 pro B 型利钠肽（NT-proBNP）>100pg/mL）增加了预测能力。在单变量和多变量分析中，高密度脂蛋白胆固醇（HDL-C）具有最高的预测能力。hs-TNT 提供了比吸烟、体重指数和葡萄糖更好的预测能力，并且在调整 HDL-C、总胆固醇和高血压后是一个独立的显著预测指标。在临床危险因素的基础上增加生物标志物可显著提高预测值（通过似然比检验，p=0.033），但并未显著提高模型的判别能力，但在随访后期似乎有助于提高敏感性。
在这个随机的中年男性人群样本中，hs-TNT 生物标志物的增加是 IHD 的独立显著预测指标，显著提高了预测效果，表明在低危人群中对 IHD 长期风险的预测效果更好。
该研究在 ClinicalTrials.gov 注册号为 NCT03138122。
