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European Heart Journal Advance Access published online on April 10, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp115
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

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

Mark Woodward1,2, Paul Welsh3, Ann Rumley3, Hugh Tunstall-Pedoe1 and Gordon D.O. Lowe3,*

1 Cardiovascular Epidemiology Unit, University of Dundee, Dundee, UK
2 Department of Medicine, Mount Sinai School of Medicine, New York University, New York, NY, USA
3 Division of Cardiovascular and Medical Sciences, University of Glasgow, Queen Elizabeth Building, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK

Received 18 August 2008; revised 4 March 2009; accepted 4 March 2009 * Corresponding author. Tel: +44 141 211 5412, Fax: +44 141 211 0414, Email: g.d.lowe{at}clinmed.gla.ac.uk

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 TNF{alpha} 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 TNF{alpha} [0.805 (95% CI 0.795–0.815); P < 0.03], but not by other combinations. C-reactive protein and TNF{alpha} yielded a significant RIDI (IL-6 almost so). C-reactive protein and TNF{alpha} 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.

Key Words: Cardiovascular disease • Risk prediction • Inflammation • C-reactive protein • Fibrinogen • Social deprivation


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