Elevated NT-proBNP levels independently predicted first cardiovascular events (HR 2.32 in men, 3.08 in women) and improved net risk reclassification by 9.2% in men and 13.3% in women.
Cohort (n=5,063)
Does the addition of NT-proBNP to classic risk factors improve the prediction of first cardiovascular and cerebrovascular events in adults aged ≥55 years without known cardiovascular disease?
Adding NT-proBNP to classic risk factors significantly improves cardiovascular risk prediction and reclassification in asymptomatic older adults.
Effect estimate: HR 2.32 (men), HR 3.08 (women) (95% CI 1.55-2.70 (men), 1.91-3.74 (women))
Increased circulating amino-terminal pro-B-type natriuretic (NT-proBNP) levels are a marker of cardiac dysfunction but also associate with coronary heart disease and stroke. We aimed to investigate whether increased circulating NT-proBNP levels have additive prognostic value for first cardiovascular and cerebrovascular events beyond classic risk factors. In a community-based cohort of 5063 participants free of cardiovascular disease, aged > or =55 years, circulating NT-proBNP levels and cardiovascular risk factors were measured. Participants were followed for the occurrence of first major fatal or nonfatal cardiovascular event. A total of 420 participants developed a first cardiovascular event (108 fatal). After adjustment for classic risk factors, the hazard ratio for cardiovascular events was 2.32 (95% CI: 1.55 to 2.70) in men and 3.08 (95% CI: 1.91 to 3.74) in women for participants with NT-proBNP in the upper compared with the lowest tertile. Corresponding hazard ratios for coronary heart disease, heart failure, and ischemic stroke were 2.01 (95% CI: 1.14 to 2.59), 2.90 (95% CI: 1.33 to 4.34), and 2.06 (95% CI: 0.91 to 3.18) for men and 2.95 (95% CI: 1.30 to 4.55), 5.93 (95% CI: 2.04 to 11.2), and 2.07 (95% CI: 1.00 to 2.97) for women. Incorporation of NT-proBNP in the classic risk model significantly improved the C-statistic both in men and women and resulted in a net reclassification improvement of 9.2% (95% CI: 3.5% to 14.9%; P=0.001) in men and 13.3% (95% CI: 5.9% to 20.8%; P<0.001) in women. We conclude that, in an asymptomatic older population, NT-proBNP improves risk prediction not only of heart failure but also of cardiovascular disease in general beyond classic risk factors, resulting in a substantial reclassification of participants to a lower or higher risk category.
Rutten et al. (Tue,) conducted a cohort in free of cardiovascular disease (n=5,063). NT-proBNP vs. lowest tertile was evaluated on first major fatal or nonfatal cardiovascular event (HR 2.32 (men), HR 3.08 (women), 95% CI 1.55-2.70 (men), 1.91-3.74 (women)). Elevated NT-proBNP levels independently predicted first cardiovascular events (HR 2.32 in men, 3.08 in women) and improved net risk reclassification by 9.2% in men and 13.3% in women.
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