Currently Viewing:
Newsroom
Currently Reading
Analysis Outlines Global Burden of Multiple Myeloma, Access to Effective Treatments
May 26, 2018 – Laura Joszt
Two Studies Evaluate Non-Tuberculous Mycobacterium Causes and Identification
May 25, 2018 – Alison Rodriguez
UnitedHealthcare, Quest Diagnostics Create Value-Based Care Arrangement for Laboratory Services
May 25, 2018 – Allison Inserro
Studies Investigate Exacerbations for Patients With COPD
May 25, 2018 – Alison Rodriguez
ADA Issues Recommendations Designed to Fix Insulin Pricing, Accessibility Crisis
May 25, 2018 – Allison Inserro
5 Abstracts to Look for at ASCO 2018
May 25, 2018 – Samantha DiGrande
This Week in Managed Care: May 25, 2018
May 25, 2018
AJMC® in the Press, May 25, 2018
May 25, 2018 – AJMC Staff
What We're Reading: Pfizer Kickback Case; Concerns for Association Health Plans; Swallowable Sensor
May 25, 2018 – Laura Joszt

Association of Biomarkers With Heart Failure With Preserved, Reduced Ejection Fraction

Jaime Rosenberg
Biomarkers of renal dysfunction, endothelial dysfunction, and inflammation were associated with incident heart failure with reduced ejection fraction. By contrast, only natriuretic peptides and urinary albumin to creatinine ratio were associated with heart failure with preserved ejection fraction (HFpEF), a finding that highlights the need for future studies focused on identifying novel biomarkers of the risk of HFpEF, according to a study in JAMA Cardiology.
There is a lack of recognized novel biomarkers of the risk of heart failure with preserved ejection fraction (HFpEF), underscoring limitations in understanding factors causing the development of HFpEF, according to a study published in JAMA Cardiology.

With heart failure occurring in 20% of men and women, there is a desire among clinicians to improve methods to identify people who are at an increased risk for heart failure and to implement preventive measures.

“Several previous studies have demonstrated the utility of targeting heart failure prevention efforts to high-risk individuals who were identified by single biomarker assessments,” wrote the authors of the study. “Individual assessment of heart failure risk, however, is still in its infancy, and the clinical applicability of existing models of assessment of heart failure is limited. Furthermore, half of patients presenting with heart failure are classified as HFpEF versus HFrEF.”

The study included 22,756 participants from 4 prospective, observational community-based cohorts: the Cardiovascular Health Study (1989-1990; 1992-1993 for supplemental African-American cohort); the Framingham Heart Study (1995-1998); the Multi-Ethnic Study of Atherosclerosis (2000-2002); and the Prevention of Renal and Vascular End-stage Disease study (1997-1998).

Statistical analysis was performed from June 25, 2015 through November 9, 2017. Medical history was documented, and physical examinations, fasting blood draws, and electrocardiography were performed at baseline examinations.

The following biomarkers were examined: N-terminal pro B-type natriuretic peptide or brain natriuretic peptide, high-sensitivity troponin T or I, C-reactive protein (CRP), UACR, renin to aldosterone ratio, D-dimer, fibrinogen, soluble suppressor of tumorigenicity, galectin-3, cystatin C, plasminogen activator inhibitor 1, and interleukin 6.

During a median follow-up of 12 years, 633 participants developed incident HFpEF, and 841 developed HFrEF. UACR (HR, 1.33; 95% CI, 1.20-1.48; P  < .001) and natriuretic peptides (HR, 1.27; 95% CI, 1.16-1.40;  < .001) were significantly associated with incident HFpEF. Meanwhile, high-sensitivity troponin (HR, 1.11; 95% CI, 1.03-1.19; P = .008), plasminogen activator inhibitor 1 (HR, 1.22; 95% CI, 1.03-1.45;  = .02), and fibrinogen (HR, 1.12; 95% CI, 1.03-1.22; P = .01) had suggestive associations with incident HFpEF.

In contrast, 6 biomarkers were associated with incident HFrEF: natriuretic peptides (HR, 1.54; 95% CI, 1.41-1.68; P  < .001), UACR (HR, 1.21; 95% CI, 1.11-1.32; P  < .001), high-sensitivity troponin (HR, 1.37; 95% CI, 1.29-1.46; P  < .001), cystatin C (HR, 1.19; 95% CI, 1.11-1.27; P  < .001), D-dimer (HR, 1.22; 95% CI, 1.11-1.35; P  < .001), and CRP (HR, 1.19; 95% CI, 1.11-1.28; P  < .001).

“In general, biomarkers modestly improved risk estimation, and discrimination metrics overall were lower for HFpEF models, highlighting current limitations in our understanding of factors underlying the development of HFpEF,” concluded the authors. “Although some studies demonstrate the potential utility of biomarker-guided prevention strategies, nuances in antecedent factors differentiating HFpEF and HFrEF highlight the need for future studies to examine the role of biomarkers in heart failure subtype-specific risk estimation.”

 
Copyright AJMC 2006-2018 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up
×

Sign In

Not a member? Sign up now!