Episode 316: 315. Prognostic Value of Cardiovascular Biomarkers in the Population

https://jamanetwork.com/journals/jama/article-abstract/2818624Conclusion--“Cardiovascular biomarkers were strongly associated with fatal and nonfatal cardiovascular events and mortality. The addition of biomarkers to established risk factors led to only a small improvement in risk prediction metrics for atherosclerotic cardiovascular disease, but was more favorable for heart failure and mortality.” For 10-year incident atherosclerotic cardiovascular disease in younger people (aged <65 years), the combination of high-sensitivity cardiac troponin I, N-terminal pro-B-type natriuretic peptide, and high-sensitivity C-reactive protein resulted in a C statistic improvement from 0.812 (95% CI, 0.8021-0.8208) to 0.8194 (95% CI, 0.8089-0.8277)  So this paper is saying look “Cardiovascular biomarkers were strongly associated with fatal and nonfatal cardiovascular events and mortality.” Not wrong these labs improve outcomes but when you look at the c stats we go from 0.81 to 0.82… remember as we talked about yesterday C-statistic gives the probability a randomly selected patient who experienced an event (e.g. a disease or condition) had a higher risk score than a patient who had not experienced the event. A score of 1 is perfect. A score of 0.5 is a coin flip. A score of .8 is pretty good but the question we have to ask ourselves “is there a difference between 0.81 and 0.82. If you are getting a grade in school is there a real difference in the knowledge between someone that gets 81% and gets 82%. Bottom line- Authors might say something is beneficial and great but if they give you the c statistics you will know weather it is actually beneficial because now you know cstatics and how to use it within a study.