AIM Cholesterol-based risk prediction is often insufficient in cardiovascular disease (CVD) patients. Ceramides are a new kind of biomarkers for CVD. The Coronary Event Risk Test (CERT) is a validated cardiovascular risk predictor that uses only circulating ceramide levels, determined by coupled liquid chromatography-mass spectrometry, to allocate patients into one of four risk categories. This test has recently been modified (CERT2) by additionally including phosphatidylcholine levels. METHODS AND RESULTS In this observational cohort study, we have recruited 999 Austrian patients with CVD and followed them for up to 13 years. We found that CERT and CERT2 both predicted cardiovascular events, cardiovascular mortality, and overall mortality. CERT2 had the higher performance compared to CERT and also to the recent cardiovascular risk score of the ESC/EAS guidelines (Systematic COronary Risk Evaluation (SCORE)) for low-risk European countries. Combining CERT2 with the ESC/EAS-SCORE, predictive capacity was further increased leading to a hazard ratio of 3.58 (2.02-6.36; P < 0.001) for cardiovascular events, 11.60 (2.72-49.56; P = 0.001) for cardiovascular mortality, and 9.86 (4.23-22.99; P < 0.001) for overall mortality when patients with very high risk (category 4) were compared to those with low risk (category 1). The use of the combined score instead of the ESC/EAS-SCORE significantly improved the predictive power according to the integrated discrimination improvement index (P = 0.004). CONCLUSION We conclude that CERT and CERT2 are powerful predictors of cardiovascular events, cardiovascular mortality, and overall mortality in CVD patients. Including phosphatidylcholine to a ceramide-based score increases the predictive performance and is best in combination with classical risk factors as used in the ESC/EAS-SCORE.

中文翻译：

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心血管疾病患者近期基于神经酰胺的冠状动脉风险预测评分的比较。

AIM 基于胆固醇的风险预测在心血管疾病 (CVD) 患者中通常不足。神经酰胺是一种新型的心血管疾病生物标志物。冠状动脉事件风险测试 (CERT) 是一种经过验证的心血管风险预测指标，它仅使用通过耦合液相色谱-质谱法确定的循环神经酰胺水平，将患者分为四个风险类别之一。该测试最近已被修改 (CERT2)，增加了磷脂酰胆碱水平。方法和结果 在这项观察性队列研究中，我们招募了 999 名奥地利 CVD 患者，并跟踪他们长达 13 年。我们发现 CERT 和 CERT2 都可以预测心血管事件、心血管死亡率和总死亡率。与 CERT 相比，CERT2 具有更高的性能，并且与欧洲低风险国家的 ESC/EAS 指南（系统冠状动脉风险评估 (SCORE)）的近期心血管风险评分相比。将 CERT2 与 ESC/EAS-SCORE 相结合，预测能力进一步提高，导致心血管事件的风险比为 3.58（2.02-6.36；P < 0.001），心血管死亡率为 11.60（2.72-49.56；P = 0.001），以及将高风险患者（4 类）与低风险患者（1 类）进行比较时，总死亡率为 9.86（4.23-22.99；P < 0.001）。根据综合辨别改善指数，使用综合评分代替 ESC/EAS-SCORE 显着提高了预测能力（P = 0.004）。结论 我们得出结论，CERT 和 CERT2 是心血管事件的有力预测因子，心血管死亡率和心血管疾病患者的总死亡率。将磷脂酰胆碱纳入基于神经酰胺的评分可提高预测性能，并且最好与 ESC/EAS-SCORE 中使用的经典风险因素结合使用。