Nt-proBNP was significantly associated with recurrent myocardial infarction, stroke, or cardiovascular death (HR 1.72 per increment SD; 95% CI 1.39-2.12; P<0.0001) beyond traditional risk factors.
Cohort (n=3,199)
Does the addition of multiple inflammatory biomarkers, microalbuminuria, and Nt-proBNP improve the prediction of recurrent cardiovascular events beyond traditional risk factors in a secondary-prevention population?
Nt-proBNP provides significant incremental predictive value beyond traditional risk factors for recurrent cardiovascular events in secondary prevention, whereas the incremental value of inflammatory biomarkers is modest.
Hazard Ratio: 1.72 (95% CI 1.39–2.12)
p-value: p=<0.0001
BACKGROUND: Individual markers of inflammation may add incremental predictive value in the context of conventionally available risk factors. We evaluated the ability of 9 inflammatory biomarkers, microalbuminuria, and N-terminal pro-brain natriuretic peptide (Nt-proBNP) to improve cardiovascular risk prediction beyond that obtained from traditional risk factors in a secondary-prevention population. METHODS AND RESULTS: We measured biomarkers representing the acute-phase reaction (C-reactive protein, fibrinogen, and interleukin-6), proinflammatory pathways (soluble tumor necrosis factor receptor-1 and -2, soluble interleukin-1 receptor antagonist, and interleukin-18), endothelial activation (soluble vascular adhesion molecule-1 and soluble intercellular adhesion molecule-1), Nt-proBNP, and microalbuminuria in 3199 study individuals of the Heart Outcomes Prevention Evaluation (HOPE) Study and assessed their association with risk of myocardial infarction, stroke, or cardiovascular death (primary outcome, n=501) over 4.5 years of follow-up. In a backward Cox regression procedure that included risk factors and biomarkers, Nt-proBNP (hazard ratio HR 1.72 per increment SD, 95% CI 1.39 to 2.12; P<0.0001), soluble intercellular adhesion molecule-1 (HR 1.46, 95% CI 1.19 to 1.80; P=0.0003), microalbuminuria (HR 1.55, 95% CI 1.22 to 1.98; P=0.0004), soluble interleukin-1 receptor antagonist (HR 1.30, 95% CI 1.05 to 1.61; P=0.02), and fibrinogen (HR 1.31, 95% CI 1.05 to 1.62; P=0.02) remained significantly related to the primary outcome. Only inclusion of Nt-proBNP provided incremental information above that obtained by models of traditional risk factors. CONCLUSIONS: Although levels of various inflammatory biomarkers are significantly related to future cardiovascular risk, their incremental predictive value is modest. A model consisting of simple traditional risk factors and Nt-proBNP provided the best clinical prediction in the secondary-prevention population.
Blankenberg et al. (2006) conducted a cohort in Cardiovascular disease (secondary prevention) (n=3,199). N-terminal pro-brain natriuretic peptide (Nt-proBNP) vs. Traditional risk factors was evaluated on Myocardial infarction, stroke, or cardiovascular death (HR 1.72, 95% CI 1.39 to 2.12, p=<0.0001). Nt-proBNP was significantly associated with recurrent myocardial infarction, stroke, or cardiovascular death (HR 1.72 per increment SD; 95% CI 1.39-2.12; P<0.0001) beyond traditional risk factors.