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To the Editor: Dr Melander and colleagues¹ suggested that gains in risk prediction using new biomarkers for cardiovascular disease are minimal using risk reclassification, a technique that can help determine whether new markers can change clinical decisions.² In contrast to similar analyses using data from the Women's Health Study, the Physicians' Health Study, and the Framingham Heart Study, there was no improvement in risk stratification with new markers, including C-reactive protein (CRP).

However, the study's methods and conclusions raise some questions. First, while the authors presented the net reclassification improvement (NRI) for each of the new markers, they did not present the NRI for the traditional markers, thus providing no basis for comparison. The NRI is similar for traditional measures and for CRP in predicting cardiovascular disease,² and this comparison would indicate the power of their study to detect important differences. Second, the NRI and integrated discrimination improvement (IDI) values . . . [Full Text of this Article]

Nancy R. Cook, ScD
ncook@rics.bwh.harvard.edu
Brigham and Women's Hospital
Boston, Massachusetts

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