Biomarkers for Prediction of Cardiovascular Events—Reply
- Olle Melander, MD, PhD olle.melander@med.lu.seDepartment of Clinical SciencesLund UniversityMalmö, Sweden;
- Christopher Newton-Cheh, MD, MPH;
- Thomas J. Wang, MDCardiology DivisionMassachusetts General HospitalBoston
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- ATRIAL NATRIURETIC FACTOR
- BIOLOGICAL MARKERS
- CARDIOVASCULAR DISEASES
- CORONARY DISEASE
- C-REACTIVE PROTEIN
- CYSTATIN C
- NATRIURETIC PEPTIDES
- PHOSPHOLIPASES
- PROADRENOMEDULLIN
- RISK ASSESSMENT
- RISK FACTORS
- STROKE
In Reply: Dr Cook suggests that our findings differ from those of prior studies. However, the proportion of individuals correctly reclassified in some of the studies she cites was relatively modest as well. For instance, in the Physicians' Health Study, the NRI for cardiovascular events was only 3.2% with the addition of both CRP and parental history of cardiovascular disease.1 Furthermore, although Cook describes risk reclassification measures as helpful in determining whether new markers can alter clinical decisions, not all reclassification is clinically meaningful. Indeed, our findings suggest that most reclassification does not involve movement across a treatment threshold and thus may not affect decision making.
We do not believe that it is appropriate to compare biomarkers such as CRP with traditional cardiovascular risk factors such as hypertension, hyperlipidemia, or smoking. These risk factors play a causal role in the development of cardiovascular disease, and their modification has been …
