Usefulness of a Coronary Artery Disease Predictive Algorithm to Predict Global Risk for Cardiovascular Disease and Acute Coronary Syndrome

Abstract

Traditional global risk assessment for cardiovascular disease fails to identify a significant percentage of the population initially classified at low or intermediate risk of cardiovascular disease that are actually at high risk for acute coronary syndrome (ACS). We examined a coronary artery disease predictive algorithm (CADPA) that includes 9 biomarkers involved in the pathogenesis of atherosclerosis initiated by endothelial damage and repair (hepatocyte growth factor, soluble FAS, Fas ligand, eotaxin, cutaneous T cell-attracting chemokine, monocyte chemotactic protein-3, interleukin-16, hemoglobin A1c, high-density lipoprotein-cholesterol), in addition to age, gender, diabetes, and family history of myocardial infarction that more accurately predicts 5-year risk of ACS to identify the patient population at discordantly high risk. We found that 34% of patients at low risk by global risk assessment and 72% of patients at intermediate risk by global risk assessment were actually at discordantly high risk for ACS. This patient population was disproportionately male and older in age. The biomarkers (per standard deviation) that most predicted the odds (95% confidence levels) of discordance were interleukin-16 (2.59 [2.21 to 3.03]), Fas Ligand (0.50 [0.43 to 0.57]), hepatocyte growth factor (1.72 [1.50 to 1.98]), soluble FAS (2.19 [1.86 to 2.58]), cutaneous T cell-attracting chemokine (0.46 [0.40 to 0.53]), and eotaxin (1.78 [1.56 to 2.03]), in addition to age, HbA1c, low-density lipoprotein-cholesterol, and glycated hemoglobin. In conclusion, although future prospective study validation is needed to establish a causal relation between CADPA and cardiovascular events, our study defines a patient population considered low to intermediate risk by conventional clinical evaluation, but who is at discordantly high risk indicated by the endothelial injury serum biomarker algorithm CADPA and may benefit from further evaluation and medical management.