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01.06.2014 | Original Paper | Ausgabe 6/2014

Clinical Research in Cardiology 6/2014

Association of multiple biomarkers and classical risk factors with early carotid atherosclerosis: results from the Gutenberg Health Study

Clinical Research in Cardiology > Ausgabe 6/2014
Christoph Sinning, Arne Kieback, Philipp S. Wild, Renate B. Schnabel, Francisco Ojeda, Sebastian Appelbaum, Tanja Zeller, Edith Lubos, Edzard Schwedhelm, Karl J. Lackner, Eike S. Debus, Thomas Munzel, Stefan Blankenberg, Christine Espinola-Klein
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00392-014-0674-6) contains supplementary material, which is available to authorized users.
For the Gutenberg Health Study.
C. Sinning and A. Kieback contributed equally to this work.



In the Gutenberg Health Study, a random sample of the population was scanned with vascular ultrasound for early atherosclerosis. A continuous classical risk marker model (waist circumference, HbA1c, LDL/HDL ratio, pack years and pulse pressure) was compared to a model of modern biomarkers (C-reactive protein, troponin I, N-terminal pro B-type natriuretic peptide, copeptin, mid-regional pro-adrenomedullin, and asymmetric dimethylarginine) with regard to the ability of ruling out abnormal intima-media thickness (IMT), respectively, carotid plaques.


Data of the first consecutive 5,000 participants (aged 35–74 years; 2,540 men, 2,460 women) were analyzed. IMT was measured at both common carotid arteries using an edge detection system. Plaques were defined as protrusion of ≥1.5 mm in common, internal and external carotid artery.


For classical risk factors, in comparison to a model of six modern biomarkers, regarding the variable (a) IMT>0.85 mm negative and positive predictive value (NPV and PPV) were 0.98 and 0.16 for both the classical risk factor model and the biomarker model. The second variable (b) presence of plaque could be ruled out with an NPV of 0.84 and identified with a PPV of 0.61 for classical risk factors, and 0.84 and 0.58 for biomarkers, respectively. Values were calculated using logistic regression analysis.


Classical risk factors allow ruling out pathologic IMT and presence of carotid plaques in a population of primary prevention in a reliable way. Modern biomarkers performed almost equally well but did not provide further information.

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