Key result
A biomarker score combining total/HDL cholesterol, hs-cTnI, NT-proBNP, and hs-CRP was strongly associated with sudden cardiac death risk (OR 1.56 per 1-unit increase; 95% CI 1.37-1.77).
Why the study?
Most sudden cardiac deaths occur in low-risk populations, and it was unknown whether specific biomarkers individually or in combination could identify individuals at higher risk.
Do elevated levels of total to HDL cholesterol ratio, hs-cTnI, NT-proBNP, and hs-CRP identify individuals at higher risk for sudden cardiac death?
Case-Control (n=1,655)
Do elevated levels of total to HDL cholesterol ratio, hs-cTnI, NT-proBNP, and hs-CRP identify individuals at higher risk for sudden cardiac death?
Effect estimate: OR 1.56 (95% CI 1.37-1.77)
A combination of biomarkers for lipids, myocardial injury, myocardial strain, and vascular inflammation can independently identify individuals at elevated risk for sudden cardiac death in apparently low-risk populations.
BACKGROUND: The majority of sudden cardiac deaths (SCDs) occur in low-risk populations often as the first manifestation of cardiovascular disease (CVD). Biomarkers are screening tools that may identify subclinical cardiovascular disease and those at elevated risk for SCD. We aimed to determine whether the total to high-density lipoprotein cholesterol ratio, high-sensitivity cardiac troponin I, NT-proBNP (N-terminal pro-B-type natriuretic peptide), or high-sensitivity C-reactive protein individually or in combination could identify individuals at higher SCD risk in large, free-living populations with and without cardiovascular disease. METHODS: We performed a nested case-control study within 6 prospective cohort studies using 565 SCD cases matched to 1090 controls (1:2) by age, sex, ethnicity, smoking status, and presence of cardiovascular disease. RESULTS: The median study follow-up time until SCD was 11.3 years. When examined as quartiles or continuous variables in conditional logistic regression models, each of the biomarkers was significantly and independently associated with SCD risk after mutually controlling for cardiac risk factors and other biomarkers. The mutually adjusted odds ratios for the top compared with the bottom quartile were 1.90 (95% CI, 1.30-2.76) for total to high-density lipoprotein cholesterol ratio, 2.59 (95% CI, 1.76-3.83) for high-sensitivity cardiac troponin I, 1.65 (95% CI, 1.12-2.44) for NT-proBNP, and 1.65 (95% CI, 1.13-2.41) for high-sensitivity C-reactive protein. A biomarker score that awarded 1 point when the concentration of any of those 4 biomarkers was in the top quartile (score range, 0-4) was strongly associated with SCD, with an adjusted odds ratio of 1.56 (95% CI, 1.37-1.77) per 1-unit increase in the score. CONCLUSIONS: Widely available measures of lipids, subclinical myocardial injury, myocardial strain, and vascular inflammation show significant independent associations with SCD risk in apparently low-risk populations. In combination, these measures may have utility to identify individuals at risk for SCD.
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Everett et al. (2020) conducted a case-control in Sudden cardiac death (n=1,655). Biomarker score (total to HDL cholesterol ratio, hs-cTnI, NT-proBNP, hs-CRP) vs. Lower biomarker concentrations was evaluated on Sudden cardiac death (OR 1.56, 95% CI 1.37-1.77). A biomarker score combining total/HDL cholesterol, hs-cTnI, NT-proBNP, and hs-CRP was strongly associated with sudden cardiac death risk (OR 1.56 per 1-unit increase; 95% CI 1.37-1.77).
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