Integrating cardiac biomarkers into the AHA PREVENT equations: impact on atherosclerotic cardiovascular disease risk stratification

AIMS: Cardiac biomarkers independently predict atherosclerotic cardiovascular disease (ASCVD) events but are not integrated into the newly developed AHA PREVENT equations. We evaluated their incremental value and clinical utility of high-sensitivity cardiac troponin T (hs-cTn) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for primary prevention based on PREVENT equations. METHODS AND RESULTS: We pooled 15 477 ASCVD-free participants from Atherosclerosis Risk in Communities and Multi-Ethnic Study of Atherosclerosis cohorts (mean age 62.0 years; 55.9% female) for primary analysis, with external validation in UK Biobank (UKB) (n = 40 359). Model performance was assessed via C-index, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA). Over a median 12.1-year follow-up, 1836 events occurred in primary cohort. Individuals with clinical low/borderline risk (