Jan 2016 In the Midspan Family study and the British Regional Heart study, inclusion of N-terminal pro B-type natriuretic peptide (NT-proBNP)and high-sensitivity troponin T (hsTnT) in cardiovascular disease risk scores improved treatment decisions among cases in both the studies. Therefore approximately 5% more people who would have gone on to develop cardiovascular disease would have been correctly treated. In contrast, in a model approximating the 10% 10-year treatment threshold, inclusion of cardiac biomarkers in the risk score in BRHS (and not Midspan Family study) resulted in improved treatment decisions among noncases only (fewer people treated). This study highlights that ongoing revisions to risk scoring guidelines that result in lower risk thresholds for commencing preventative treatments impact the utility (and underlying health economic justifications) for biomarker measurements. This is an important concept to highlight in light of ongoing revisions to the risk scores.
Paper. Welsh P, Hart C, Papacosta O, Preiss D, McConnachie A, Murray H, Ramsay S, Upton M, Watt G, Whincup P, Wannamethee G, Sattar N. Prediction of Cardiovascular Disease Risk by Cardiac Biomarkers in 2 United Kingdom Cohort Studies Does Utility Depend on Risk Thresholds For Treatment?
Hypertension. 2016;67:309-315. DOI: 10.1161/HYPERTENSIONAHA.115.06501 (Note this paper is open access to pdf)