Assessment of Improved Prediction Beyond Traditional Risk Factors

Abstract

The moderate predictive performance of cardiovascular disease risk models necessitates more studies that investigate the incremental value of novel biomarkers. In recent years, many new biomarkers have been evaluated for their ability to improve prediction of cardiovascular disease beyond traditional risk factors, including C-reactive protein, coronary artery calcium, and single-nucleotide polymorphisms in the 9p21 region.1 The interest in novel biomarkers is propelled, in part, by emerging discoveries from genomewide association studies of genetic variants associated with risk for many common diseases.2 Nonetheless, family history, an “old” tool in clinical practice—crucial for the diagnosis and management of genetic disorders—has not been adequately explored for its value in risk assessment and prevention of common diseases.3 Positive family history is a strong risk factor for cardiovascular diseases,4,5 reflecting the consequences of genetic and nongenetic risk factors that are shared among relatives. From a practical perspective, family history is a strong determinant of disease that is relatively easy to assess. For this reason, family history is advocated as a useful tool for identifying individuals at increased risk of disease and for tailoring preventive interventions.4,6,7 However, the challenge is to show that this knowledge has clinical utility for improving health.8 Article see p 97 In this issue of Circulation: Cardiovascular Genetics , Scheuner et al9 report the incremental value of adding family history information to the General Cardiovascular Risk Profile to improve identification of individuals with advanced coronary artery calcification. The incremental value of family history in disease prediction is assessed in several questions10: 1. Does family history improve prediction beyond traditional risk factors? 2. Does improved prediction change treatment decisions or health recommendations? 3. Do these changes improve health outcomes or have other benefits? 4. Do the incremental benefits outweigh the extra costs? This evaluation is a stepwise …