The Role of Risk Stratification and Biomarkers in Prevention of CVD

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]

The Role of Risk Stratification and Biomarkers in Prevention of CVD

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Editor's Notes