{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T07:19:29Z","timestamp":1793085569837,"version":"4.5.0"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T00:00:00Z","timestamp":1730246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014538","name":"The Indonesia Endowment Fund for Education","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100014538","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100019899","name":"Ministry of Finance of the Republic of Indonesia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100019899","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>This study aims to explore whether conventional and emerging biomarkers could improve risk discrimination and calibration in the secondary prevention of recurrent atherosclerotic cardiovascular disease (ASCVD), based on a model using predictors from SMART2 (Secondary Manifestations of ARTerial Disease).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>In a cohort of 20 658 UK Biobank participants with medical history of ASCVD, we analysed any improvement in C indices and net reclassification index (NRI) for future ASCVD events, following addition of lipoprotein A (LP-a), apolipoprotein B, Cystatin C, Hemoglobin A1c (HbA1c), gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), alanine aminotransferase, and alkaline phosphatase (ALP), to a model with predictors used in SMART2 for the outcome of recurrent major cardiovascular event. We also examined any improvement in C indices and NRIs replacing creatinine-based estimated glomerular filtration rate (eGFR) with Cystatin C\u2013based estimates. Calibration plots between different models were also compared. Compared with the baseline model (C index = 0.663), modest increments in C indices were observed when adding HbA1c (\u0394C = 0.0064, P &amp;lt; 0.001), Cystatin C (\u0394C = 0.0037, P &amp;lt; 0.001), GGT (\u0394C = 0.0023, P &amp;lt; 0.001), AST (\u0394C = 0.0007, P &amp;lt; 0.005) or ALP (\u0394C = 0.0010, P &amp;lt; 0.001) or replacing eGFRCr with eGFRCysC (\u0394C = 0.0036, P &amp;lt; 0.001) or eGFRCr-CysC (\u0394C = 0.00336, P &amp;lt; 0.001). Similarly, the strongest improvements in NRI were observed with the addition of HbA1c (NRI = 0.014) or Cystatin C (NRI = 0.006) or replacing eGFRCr with eGFRCr-CysC (NRI = 0.001) or eGFRCysC (NRI = 0.002). There was no evidence that adding biomarkers modified calibration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Adding several biomarkers, most notably Cystatin C and HbA1c, but not LP-a, in a model using SMART2 predictors modestly improved discrimination.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwae352","type":"journal-article","created":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T20:15:02Z","timestamp":1730146502000},"page":"585-595","source":"Crossref","is-referenced-by-count":9,"title":["Adding traditional and emerging biomarkers for risk assessment in secondary prevention: a prospective cohort study of 20 656 patients with cardiovascular disease"],"prefix":"10.1093","volume":"32","author":[{"given":"Ike Dhiah","family":"Rochmawati","sequence":"first","affiliation":[{"name":"School of Health and Wellbeing, University of Glasgow , 90 Byres Road, Glasgow G12 8TB ,","place":["UK"]},{"name":"Department of Clinical and Community Pharmacy, Faculty of Pharmacy, University of Surabaya , Jalan Raya Kalirungkut, Surabaya 60293 ,","place":["Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salil","family":"Deo","sequence":"additional","affiliation":[{"name":"Louis Stokes Cleveland VA Medical Center , 10701 East Blvd, Cleveland, OH 44106 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6331-0178","authenticated-orcid":false,"given":"Jennifer S","family":"Lees","sequence":"additional","affiliation":[{"name":"School of Cardiovascular and Metabolic Health, University of Glasgow , 126 University Place, Glasgow G12 8TA ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3387-2123","authenticated-orcid":false,"given":"Patrick B","family":"Mark","sequence":"additional","affiliation":[{"name":"School of Cardiovascular and Metabolic Health, University of Glasgow , 126 University Place, Glasgow G12 8TA ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1604-2593","authenticated-orcid":false,"given":"Naveed","family":"Sattar","sequence":"additional","affiliation":[{"name":"School of Cardiovascular and Metabolic Health, University of Glasgow , 126 University Place, Glasgow G12 8TA ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Celis-Morales","sequence":"additional","affiliation":[{"name":"School of Cardiovascular and Metabolic Health, University of Glasgow , 126 University Place, Glasgow G12 8TA ,","place":["UK"]},{"name":"Human Performance Lab, Education, Physical Activity and Health Research Unit, University Cat\u00f3lica del Maule , San Miguel Avenue 3605, Talca 3466706 ,","place":["Chile"]},{"name":"Centro de Investigacion en Medicina de Altura (CEIMA), Universidad Arturo Prat , Avenue Arturo Prat, Iquique 2120 ,","place":["Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill P","family":"Pell","sequence":"additional","affiliation":[{"name":"School of Health and Wellbeing, University of Glasgow , 90 Byres Road, Glasgow G12 8TB ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7970-3643","authenticated-orcid":false,"given":"Paul","family":"Welsh","sequence":"additional","affiliation":[{"name":"School of Cardiovascular and Metabolic Health, University of Glasgow , 126 University Place, Glasgow G12 8TA ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7190-9025","authenticated-orcid":false,"given":"Frederick K","family":"Ho","sequence":"additional","affiliation":[{"name":"School of Health and Wellbeing, 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