Key result
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.
Why the study?
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?
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.
Answers are grounded in this paper and cite their sources.
May aid secondary-prevention risk stratification; extends biomarker data but leaves clinical adoption open.
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.
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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.
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