Prognostic Value of NT-pro-BNP and Hs-CRP for Risk Stratification in Primary Care: Results from the Population-based DETECT Study

Overview

Journal Clin Res Cardiol

Specialty Cardiology & Vascular Diseases

Date 2013 Jan 5

PMID 23288467

Citations 22

Authors

David M Leistner

Jens Klotsche

Lars Pieper

Sylvia Palm

Gunter K Stalla

Hendrik Lehnert

Sigmund Silber

Winfried Marz

Hans-Ulrich Wittchen

Andreas M Zeiher

Affiliations

Soon will be listed here.

Abstract

Background: There is continuous debate to the use of biomarkers in the general practitioners office and to what degree the established biomarkers N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and high-sensitive C-reactive protein (hs-CRP) might contribute to improved prediction of incident cardiovascular events.

Objective: To evaluate the utility and 5-year predictive value of a single measurement of NT-pro-BNP and hs-CRP for incident cardiovascular events, and its added value beyond the contribution of conventional risk factors in primary care.

Methods: Five year prospective longitudinal clinical epidemiological study in a nationwide sample of 4,775 primary care subjects (mean age 55.8 years, 62 % women) without coronary artery disease at baseline. Main outcome measures were incident major cardiovascular events and all-cause death.

Results: During the 5 years of follow-up, 188 subjects (3.9 %) died or experienced a first major cardiovascular event. The addition of NT-pro-BNP, but not of hs-CRP to a prediction model with established cardiovascular risk factors improved the prediction of major cardiovascular events (increase in C statistic by 0.009; p = 0.008), and was associated with a significant improvement in net reclassification improvement (NRI = 23.6 %; p = 0.003).

Conclusion: In a primary care setting, one single measurement of NT-pro-BNP, but not of hs-CRP significantly improves the prediction of incident cardiovascular events.

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References

. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106(25):3143-421. View

Grundy S . The changing face of cardiovascular risk. J Am Coll Cardiol. 2005; 46(1):173-5. DOI: 10.1016/j.jacc.2005.05.007. View

Bohm M, Voors A, Ketelslegers J, Schirmer S, Turgonyi E, Bramlage P . Biomarkers: optimizing treatment guidance in heart failure. Clin Res Cardiol. 2011; 100(11):973-81. DOI: 10.1007/s00392-011-0341-0. View

Ridker P, Danielson E, Fonseca F, Genest J, Gotto Jr A, Kastelein J . Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008; 359(21):2195-207. DOI: 10.1056/NEJMoa0807646. View

Blankenberg S, Zeller T, Saarela O, Havulinna A, Kee F, Tunstall-Pedoe H . Contribution of 30 biomarkers to 10-year cardiovascular risk estimation in 2 population cohorts: the MONICA, risk, genetics, archiving, and monograph (MORGAM) biomarker project. Circulation. 2010; 121(22):2388-97. DOI: 10.1161/CIRCULATIONAHA.109.901413. View

Pearson T, Blair S, Daniels S, Eckel R, Fair J, Fortmann S . AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. American Heart Association.... Circulation. 2002; 106(3):388-91. DOI: 10.1161/01.cir.0000020190.45892.75. View

Melander O, Newton-Cheh C, Almgren P, Hedblad B, Berglund G, Engstrom G . Novel and conventional biomarkers for prediction of incident cardiovascular events in the community. JAMA. 2009; 302(1):49-57. PMC: 3090639. DOI: 10.1001/jama.2009.943. View

Simon T, Becker R, Voss F, Bikou O, Hauck M, Licka M . Elevated B-type natriuretic peptide levels in patients with nonischemic cardiomyopathy predict occurrence of arrhythmic events. Clin Res Cardiol. 2008; 97(5):306-9. DOI: 10.1007/s00392-007-0629-2. View

Wannamethee S, Welsh P, Lowe G, Gudnason V, Di Angelantonio E, Lennon L . N-terminal pro-brain natriuretic Peptide is a more useful predictor of cardiovascular disease risk than C-reactive protein in older men with and without pre-existing cardiovascular disease. J Am Coll Cardiol. 2011; 58(1):56-64. DOI: 10.1016/j.jacc.2011.02.041. View

10.

Olsen M, Hansen T, Christensen M, Gustafsson F, Rasmussen S, Wachtell K . N-terminal pro-brain natriuretic peptide, but not high sensitivity C-reactive protein, improves cardiovascular risk prediction in the general population. Eur Heart J. 2007; 28(11):1374-81. DOI: 10.1093/eurheartj/ehl448. View

11.

Manjer J, Carlsson S, Elmstahl S, Gullberg B, Janzon L, Lindstrom M . The Malmö Diet and Cancer Study: representativity, cancer incidence and mortality in participants and non-participants. Eur J Cancer Prev. 2002; 10(6):489-99. DOI: 10.1097/00008469-200112000-00003. View

12.

Wittchen H, Glaesmer H, Marz W, Stalla G, Lehnert H, Zeiher A . Cardiovascular risk factors in primary care: methods and baseline prevalence rates--the DETECT program. Curr Med Res Opin. 2005; 21(4):619-30. DOI: 10.1185/030079905X38187. View

13.

Ridker P, Glynn R, Hennekens C . C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction. Circulation. 1998; 97(20):2007-11. DOI: 10.1161/01.cir.97.20.2007. View

14.

Zethelius B, Berglund L, Sundstrom J, Ingelsson E, Basu S, Larsson A . Use of multiple biomarkers to improve the prediction of death from cardiovascular causes. N Engl J Med. 2008; 358(20):2107-16. DOI: 10.1056/NEJMoa0707064. View

15.

Ridker P, Buring J, Rifai N, Cook N . Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score. JAMA. 2007; 297(6):611-9. DOI: 10.1001/jama.297.6.611. View

16.

Wang T, Gona P, Larson M, Tofler G, Levy D, Newton-Cheh C . Multiple biomarkers for the prediction of first major cardiovascular events and death. N Engl J Med. 2006; 355(25):2631-9. DOI: 10.1056/NEJMoa055373. View

17.

Meisinger C, Heier M, von Scheidt W, Kuch B . Admission C-reactive protein and short- as well as long-term mortality in diabetic versus non-diabetic patients with incident myocardial infarction. Clin Res Cardiol. 2010; 99(12):817-23. DOI: 10.1007/s00392-010-0193-z. View

18.

Khot U, Khot M, Bajzer C, Sapp S, Ohman E, Brener S . Prevalence of conventional risk factors in patients with coronary heart disease. JAMA. 2003; 290(7):898-904. DOI: 10.1001/jama.290.7.898. View

19.

Pencina M, DAgostino R . Overall C as a measure of discrimination in survival analysis: model specific population value and confidence interval estimation. Stat Med. 2004; 23(13):2109-23. DOI: 10.1002/sim.1802. View

20.

McKie P, Cataliotti A, Lahr B, Martin F, Redfield M, Bailey K . The prognostic value of N-terminal pro-B-type natriuretic peptide for death and cardiovascular events in healthy normal and stage A/B heart failure subjects. J Am Coll Cardiol. 2010; 55(19):2140-7. PMC: 3770189. DOI: 10.1016/j.jacc.2010.01.031. View