Predictors of secondary cardiovascular events
Dallmeier Rojas, Dhayana Elizabeth
MetadataShow full item record
Cardiovascular diseases (CVD) are the number one cause of death worldwide. About one fifth of those who survived a myocardial infarction will suffer a recurrent cardiovascular event (CVE). Given the low participation in recommended cardiac rehabilitation, there is interest in early risk stratification after a primary CVE. This dissertation evaluates leisure time physical activity (LTPA), N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) and cystatin C as predictors of a secondary CVE in a German cohort of cardiac rehabilitation patients with stable coronary heart disease followed from 1999 to 2008. Study 1 evaluated self-reported LTPA at one-year follow-up. Those reporting seldom/never practice of LTPA showed a higher risk (Hazard Ratio (HR) 1.30 [95% Confidence Interval (CI) 0.62, 2.69]), while those reporting LTPA at least 5-6 times/week had a reduced risk (HR 0.88 [95% CI 0.54, 1.43]) for a subsequent CVE, when compared to the reference group (1-4 times/month). Study 2 examined LTPA trajectories during the age period 20-49 years. Compared to those with a gradual decline of LTPA, the highest risk was observed among those with a steeper decrease of LTPA (HR 1.59 [95% CI 0.97, 2.62]). A continuous increase of LTPA was associated with a risk reduction (HR 0.71 [95% CI 0.41, 1.22]) with respect to a recurrent CVE. Studies 3 and 4 evaluated the prognostic value of two novel biomarkers, when added to a model containing well-established CVD risk factors. In Study 3, NT-proBNP levels at one-year follow-up and a 10% increase in the slope of a NT-proBNP three-year trajectory were associated with a subsequent CVE ,with HRs of 1.63 [95% CI 1.17, 2.27] and 1.24 [95% CI 1.12, 1.37], respectively. One-year, but not baseline, levels of NT-proBNP showed an improvement in risk reclassification. Study 4 examined cystatin C versus creatinine. Although both were associated with a recurrent CVE, only the addition of cystatin C improved model performance, discrimination and reclassification. In conclusion, in patients with stable coronary heart disease, LTPA, NT-proBNP, and cystatin C might help to identify individuals at high risk for a recurrent CVE. Further research is needed to evaluate treatment modalities for secondary prevention in this group.
RightsAttribution-NonCommercial-ShareAlike 4.0 International