Key result
Baseline NT-proBNP was associated with an increased risk of cardiovascular disease (HR 1.17; 95% CI 1.11-1.23 per standard deviation increase) over 15 years in men with hypercholesterolaemia.
Why the study?
Does baseline NT-proBNP improve the prediction of cardiovascular disease events beyond traditional risk factors in middle-aged men with hypercholesterolaemia?
Cohort (n=4,801)
Does baseline NT-proBNP improve the prediction of cardiovascular disease events beyond traditional risk factors in middle-aged men with hypercholesterolaemia?
Baseline NT-proBNP independently predicts cardiovascular events and improves risk discrimination beyond traditional risk factors and CRP in men without clinical evidence of coronary heart disease.
AIMS: To test whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) was independently associated with, and improved the prediction of, cardiovascular disease (CVD) in a primary prevention cohort. METHODS AND RESULTS: In the West of Scotland Coronary Prevention Study (WOSCOPS), a cohort of middle-aged men with hypercholesterolaemia at a moderate risk of CVD, we related the baseline NT-proBNP (geometric mean 28 pg/mL) in 4801 men to the risk of CVD over 15 years during which 1690 experienced CVD events. Taking into account the competing risk of non-CVD death, NT-proBNP was associated with an increased risk of all CVD [HR: 1.17 (95% CI: 1.11-1.23) per standard deviation increase in log NT-proBNP] after adjustment for classical and clinical cardiovascular risk factors plus C-reactive protein. N-terminal pro-B-type natriuretic peptide was more strongly related to the risk of fatal [HR: 1.34 (95% CI: 1.19-1.52)] than non-fatal CVD [HR: 1.17 (95% CI: 1.10-1.24)] (P= 0.022). The addition of NT-proBNP to traditional risk factors improved the C-index (+0.013; P < 0.001). The continuous net reclassification index improved with the addition of NT-proBNP by 19.8% (95% CI: 13.6-25.9%) compared with 9.8% (95% CI: 4.2-15.6%) with the addition of C-reactive protein. N-terminal pro-B-type natriuretic peptide correctly reclassified 14.7% of events, whereas C-reactive protein correctly reclassified 3.4% of events. Results were similar in the 4128 men without evidence of angina, nitrate prescription, minor ECG abnormalities, or prior cerebrovascular disease. CONCLUSION: N-terminal pro-B-type natriuretic peptide predicts CVD events in men without clinical evidence of CHD, angina, or history of stroke, and appears related more strongly to the risk for fatal events. N-terminal pro-B-type natriuretic peptide also provides moderate risk discrimination, in excess of that provided by the measurement of C-reactive protein. Clinical trial registration WOSCOPS was carried out and completed prior to the requirement for clinical trial registration.
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Welsh et al. (2012) conducted a cohort in Hypercholesterolaemia at moderate risk of CVD (n=4,801). N-terminal pro-B-type natriuretic peptide (NT-proBNP) was evaluated on All cardiovascular disease (CVD) (HR 1.17, 95% CI 1.11-1.23). Baseline NT-proBNP was associated with an increased risk of cardiovascular disease (HR 1.17; 95% CI 1.11-1.23 per standard deviation increase) over 15 years in men with hypercholesterolaemia.
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