Key result
A multi-marker risk score accurately predicts long-term renal and CV risk reductions with ARB therapy.
Why the study?
Does a risk score incorporating short-term changes in multiple risk markers more accurately predict long-term renal and cardiovascular protection of ARBs compared to single markers?
Observational
Does a risk score incorporating short-term changes in multiple risk markers more accurately predict long-term renal and cardiovascular protection of ARBs compared to single markers?
p-value: P = 0.44 for renal; P = 0.98 for cardiovascular
Predictions of long-term renal and cardiovascular ARB effects are more accurate when considering short-term changes in multiple risk markers, challenging the reliance on single markers to establish drug efficacy.
Angiotensin receptor blockers (ARBs) have multiple effects that may contribute to their efficacy on renal/cardiovascular outcomes. We developed and validated a risk score that incorporated short-term changes in multiple risk markers to predict the ARB effect on renal/cardiovascular outcomes. The score was used to predict renal/cardiovascular risk at baseline and at month 6 in the ARB treatment arm of the Reduction of Endpoints in NIDDM (noninsulin-dependent diabetes mellitus) with the Angiotensin II Antagonist Losartan (RENAAL) trial. The net risk difference at these time points indicated the estimated long-term renal/cardiovascular treatment effect. Predicted relative risk reductions (RRRs) based on multiple markers were close to observed RRRs for renal (RRR(predicted): 30.1% vs. RRR(observed): 21.8%; P = 0.44) and cardiovascular outcomes (RRR(predicted): 9.4% vs. RRR(observed): 9.2%; P = 0.98), in addition to being markedly more accurate than predicted RRRs based on changes in single markers. The score was validated in an independent ARB trial. Predictions of long-term renal/cardiovascular ARB effects are more accurate when considering short-term changes in multiple risk markers, challenging the use of single markers to establish drug efficacy.
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Smink et al. (2013) conducted an observational in Noninsulin-dependent diabetes mellitus (NIDDM). Risk score incorporating short-term changes in multiple risk markers vs. Single risk markers was evaluated on Predicted vs observed relative risk reductions for renal and cardiovascular outcomes (p=P = 0.44 for renal; P = 0.98 for cardiovascular). A risk score incorporating short-term changes in multiple risk markers accurately predicted long-term relative risk reductions for renal (P=0.44) and cardiovascular (P=0.98) outcomes with ARB therapy.
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