Cardiovascular Disease Risk Assessment With High-Sensitivity Cardiac Troponin I And Other Biomarkers: An Observational Cohort Study In Johor, Malaysia

@#Although cardiovascular disease (CVD) is a major health challenge in Malaysia, many Malaysians are unaware of their CVD risk. The measurement of biomarkers in the general population may help to identify at-risk individuals before the onset of symptomatic CVD. The aim of this community health screening project was to determine the distribution of high-sensitivity troponin I (hsTnI) and other biomarkers of CVD risk in the general population of Johor, Malaysia. A sampling of self-declared healthy volunteers was conducted during the 2016 Kembara Mahkota community event in Johor. Levels of hsTnI, B-type natriuretic peptide (BNP) and homocysteine (HCY) were analyzed using the ARCHITECT immunoassay and clinical chemistry platforms utilizing fresh venous blood samples. Based on previous data, biomarker levels indicative of high risk were >10 and >12 ng/mL for hsTnI in women and men, respectively, BNP >50 pg/mL in the overall population, and HCY >13.6 µmol/L in women and >16.2 µmol/L in men. A total of 2744 volunteers participated in biomarker testing. Biomarker measurements showed that up to 10% of participants had moderate or high CVD risk based on hsTnI, approximately 2% were above the BNP threshold and >50% of subjects were above the HCY threshold. General population biomarker testing shows distribution of biomarker levels that may be indicative of CVD risk or the presence of disease and suggests that biomarker-guided risk strategies should be more widely implemented to determine the impact they would have on early detection and prevention of disease.

Distinguishing benign from malignant pelvic mass utilizing an algorithm with HE4, menopausal status, and ultrasound findings / 부인종양

OBJECTIVE: The purpose of this study was to develop a risk prediction score for distinguishing benign ovarian mass from malignant tumors using CA-125, human epididymis protein 4 (HE4), ultrasound findings, and menopausal status. The risk prediction score was compared to the risk of malignancy index and risk of ovarian malignancy algorithm (ROMA). METHODS: This was a prospective, multicenter (n=6) study with patients from six Asian countries. Patients had a pelvic mass upon imaging and were scheduled to undergo surgery. Serum CA-125 and HE4 were measured on preoperative samples, and ultrasound findings were recorded. Regression analysis was performed and a risk prediction model was developed based on the significant factors. A bootstrap technique was applied to assess the validity of the HE4 model. RESULTS: A total of 414 women with a pelvic mass were enrolled in the study, of which 328 had documented ultrasound findings. The risk prediction model that contained HE4, menopausal status, and ultrasound findings exhibited the best performance compared to models with CA-125 alone, or a combination of CA-125 and HE4. This model classified 77.2% of women with ovarian cancer as medium or high risk, and 86% of women with benign disease as very-low, low, or medium-low risk. This model exhibited better sensitivity than ROMA, but ROMA exhibited better specificity. Both models performed better than CA-125 alone. CONCLUSION: Combining ultrasound with HE4 can improve the sensitivity for detecting ovarian cancer compared to other algorithms.

Prevalence of abnormal maternal TPO-Ab and TSH levels in pregnant women in the Malaysian population

Background: Undiagnosed thyroid disease is a common problem with significant public health implications. This is especially true during pregnancy, when the health of the mother and child can be adversely affected by abnormal thyroid function. Measurement of thyroid stimulating hormone (TSH) and antibodies to thyroid peroxidase (TPO-Ab) are two important ways to assess maternal thyroid status.Objective: The purpose of our evaluation was to determine the prevalence of abnormal thyroid function by testing a population of pregnant women at the Obstetric Clinic, University Malaya Medical Center, Malaysia.Method: We assayed serum samples (n= 609) of pregnant partum women (age range 20-45) on the Abbott AxSYM platform using a 3rd generation TSH assay and TPO-Ab. Results outside the manufacturer’s reference range (TSH= 0.47-4.64 μIU/mL; TPO Ab \< 12 IU/mL) were considered to be abnormal.Result: Overall prevalence for an abnormal test result was 21.3%. Across the different age groups, the average prevalence for an abnormal result was TSH=10.3% and TPO-Ab=10.8%. If, as in the NACB thyroid testing guidelines, a more narrow TSH reference range (0.4-2.5 μIU/mL) was applied to our data, the prevalence of abnormal TSH results increased to 14.9%.Conclusion: Our data show a high prevalence of abnormal thyroid function in this population, and suggest that routine screening of pregnant women for thyroid dysfunction may be appropriate in addition to routine prenatal care.