Do inflammatory biomarkers add to the discrimination of cardiovascular disease after allowing for social deprivation? Results from a 10-year cohort study in Glasgow, Scotland.
Woodward M., Welsh P., Rumley A., Tunstall-Pedoe H., Lowe GDO.
AIMS: To assess the additional discriminative value of adding each of five inflammatory biomarkers to the ASSIGN risk score, which includes social deprivation. METHODS AND RESULTS: In this study, 1319 men and women aged 25-64 in the fourth Glasgow MONICA study were followed-up for cardiovascular endpoints. Baseline C-reactive protein, fibrinogen, IL-6, IL-18, and TNFα were related to risk of CVD. The discriminative value of adding each to the ASSIGN score was assessed using area under the receiver operating characteristic (AUC) and relative integrated percentage improvement in classification (RIDI). During a median of 10.5 years, 151 CVD events occurred. After adjusting for ASSIGN variables, each inflammatory marker except IL-18 had a significant (P < 0.05) association with CVD risk. The AUC using ASSIGN [0.799 (95% CI 0.790-0.809)] was improved by the inclusion of C-reactive protein and TNFα [0.805 (95% CI 0.795-0.815); P < 0.03], but not by other combinations. C-reactive protein and TNFα yielded a significant RIDI (IL-6 almost so). C-reactive protein and TNFα together improved the classification of risk by 11% (95% CI, 3-19%) when added to the ASSIGN variables. CONCLUSION: Some inflammatory biomarkers add moderate discriminative information to the ASSIGN CVD risk score. The clinical utility of this information, cost-effectiveness, and optimization should be assessed in future studies.