Biomarkers and degree of atherosclerosis are independently associated with incident atherosclerotic cardiovascular disease in a primary prevention cohort: The ARIC study

Atherosclerosis. 2016 Oct;253:156-163. doi: 10.1016/j.atherosclerosis.2016.08.028. Epub 2016 Aug 25.


Background and aims: Biomarkers and atherosclerosis imaging have been studied individually for association with incident cardiovascular disease (CVD); however, limited data exist on whether the biomarkers are associated with events with a similar magnitude in the presence of atherosclerosis. In this study, we assessed whether the presence of atherosclerosis as measured by carotid intima media thickness (cIMT) affects the association between biomarkers known to be associated with coronary heart disease (CHD) and incident cardiovascular disease (CVD) in a primary prevention cohort.

Methods: 8127 participants from the ARIC study (4th visit, 1996-1998) were stratified as having minimal, mild, or substantial atherosclerosis by cIMT. Levels of C-reactive protein, lipoprotein-associated phospholipase A2, cardiac troponin T, N-terminal pro-brain natriuretic peptide, lipoprotein(a), cystatin C, and urine albumin to creatinine ratio were measured in each participant. Hazard ratios were used to determine the relationship between the biomarkers and incident CHD, stroke, and CVD in each category of atherosclerosis.

Results: While each of the biomarkers was significantly associated with risk of events overall, we found no significant differences noted in the strength of association of biomarkers with CHD, stroke, and CVD when analyzed by degree of atherosclerosis.

Conclusions: These findings suggest that the level of atherosclerosis does not significantly influence the association between biomarkers and CVD.

Keywords: Cardiovascular disease; Carotid intima media thickness; Coronary heart disease; High sensitivity C- reactive protein; High sensitivity troponin T; Lipoprotein associated phospholipase A2; NT-pro B-type natriuretic peptide; Stroke; lipoprotein(a).

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • 1-Alkyl-2-acetylglycerophosphocholine Esterase / blood
  • Albuminuria / blood
  • Atherosclerosis / blood*
  • Atherosclerosis / complications
  • Biomarkers / blood*
  • Biomarkers / metabolism
  • C-Reactive Protein / analysis
  • Cardiovascular Diseases / blood*
  • Cardiovascular Diseases / complications
  • Carotid Intima-Media Thickness
  • Cohort Studies
  • Cystatin C / blood
  • Female
  • Humans
  • Incidence
  • Lipoprotein(a) / blood
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Peptide Fragments / blood
  • Primary Prevention / methods
  • Prospective Studies
  • Smoking
  • Troponin T / blood
  • United States


  • Biomarkers
  • Cystatin C
  • Lipoprotein(a)
  • Peptide Fragments
  • Troponin T
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • C-Reactive Protein
  • 1-Alkyl-2-acetylglycerophosphocholine Esterase