Role of CVD Risk Biomarkers in Prevention

The role of risk stratification and biomarkers in prevention of CVD CVD Risk Biomarker Symposium Mark J. Pletcher, MD, MPH 1/30/2012

Objective ,[object Object],[object Object]

Objective ,[object Object],[object Object],[object Object],[object Object],[object Object]

Outline ,[object Object],[object Object],[object Object],[object Object]

Framework ,[object Object],[object Object],[object Object],[object Object],[object Object],What KIND of evidence?

Framework Circulation 2009;119: 2408-16.

Framework Circulation 2009;119: 2408-16. Association (Discrimination)

Framework Circulation 2009;119: 2408-16. Reclassification

Framework Circulation 2009;119: 2408-16. Impact

Framework ,[object Object],[object Object],Circulation 2011;123:1116-1124

Framework ,[object Object],[object Object],[object Object],[object Object],Circulation 2011;123:1116-1124

Framework ,[object Object],[object Object],[object Object],[object Object],[object Object],Circulation 2011;123:1116-1124

Example 1: Multimarker panel ,[object Object],[object Object],[object Object],NEJM 2006;355:2631-9

Example 1: Multimarker panel ,[object Object],NEJM 2006;355:2631-9

Example 1: Multimarker panel ,[object Object],NEJM 2006;355:2631-9 C-statistic: 0.80  0.82

Example 2: CRP ,[object Object],[object Object],Annals 2006;145:21-29

Example 2: CRP ,[object Object],[object Object],[object Object],[object Object],[object Object],Annals 2006;145:21-29

Example 2: CRP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Annals 2006;145:21-29

Example 2: CRP ,[object Object],Annals 2006;145:21-29 Intermediate risk ppts reclassified: 20% (And reclassified persons’ expected risk closer to what was observed)

Example 2: CRP ,[object Object],[object Object],[object Object],Annals 2006;145:21-29

The Common Flaw ,[object Object],[object Object],[object Object],[object Object],[object Object],Circulation 2011;123:1116-1124

The Common Flaw ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Circulation 2011;123:1116-1124

The Answer ,[object Object],Circulation 2011;123:1116-1124

The Answer ,[object Object],[object Object],[object Object],[object Object],[object Object],Circulation 2011;123:1116-1124

Measuring Health Impact ,[object Object],[object Object],[object Object],[object Object],Circulation 2011;123:1116-1124

Measuring Health Impact ,[object Object],[object Object],[object Object],[object Object],[object Object],Circulation 2011;123:1116-1124

Measuring Health Impact ,[object Object],[object Object],[object Object],Circulation 2011;123:1116-1124

Measuring Health Impact ,[object Object],Study sample Randomize Do not measure biomarker Intervention tailored to biomarker level Standard intervention Measure health outcomes Measure health outcomes Measure biomarker Circulation 2011;123:1116-1124

Measuring Health Impact ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Circulation 2011;123:1116-1124

Measuring Health Impact ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Circulation 2011;123:1116-1124

Measuring Health Impact ,[object Object]

Measuring Health Impact ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Circulation 2011;123:1116-1124

Measuring Health Impact ,[object Object],[object Object],RCT DCEA Model

Measuring Health Impact ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Measuring Health Impact ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

For the rest of the day… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Thank you to our sponsors! ,[object Object],[object Object],[object Object],[object Object]

Role of CVD Risk Biomarkers in Prevention

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Editor's Notes