In 85-year-old patients with established cardiovascular disease, NT-proBNP was the strongest predictor of 5-year recurrent cardiovascular events and mortality (HR 1.7).
Cohort (n=282)
No
Does the addition of NT-proBNP to traditional risk markers improve the prediction of recurrent cardiovascular events and mortality in 85-year-old patients with established cardiovascular disease?
In very old patients with established cardiovascular disease, measuring NT-proBNP significantly improves the prediction of recurrent cardiovascular events and mortality beyond traditional risk factors.
Effect estimate: HR 1.7 (95% CI 1.4-2.1)
BACKGROUND: In the aging population cardiovascular disease (CVD) is highly prevalent. Identification of very old persons at high risk of recurrent CVD is difficult, since traditional risk markers loose predictive value with age. METHODS: In a population-based sample of 282 85-year old participants with established CVD from the Leiden 85-plus Study, we studied predictive values of traditional cardiovascular risk markers, a history of major CVD (myocardial infarction, stroke or arterial surgery), and new cardiovascular biomarkers (estimated glomerular filtration rate (MDRD), C-reactive protein (CRP), homocysteine and N-terminal pro B-type natriuretic peptide (NT-proBNP)) regarding 5-year risk of recurrent cardiovascular events and mortality (composite endpoint). RESULTS: During complete 5-year follow-up 157 (56%) participants died. 109 (39%) had a cardiovascular event or died from cardiovascular causes. Individually related to the composite endpoint were: a history of major CVD (HR 1.5 (95%CI 1.03-2.3)), CRP (HR 1.3 (95%CI 1.03-1.5)), homocysteine (HR 1.4 (95%CI 1.2-2.6)) and NT-proBNP (HR 1.7 (95%CI 1.4-2.1)). A prediction model including all traditional risk markers yielded a C-statistic of 0.59 (95%CI 0.52-0.66). Of all five new markers only addition of NT-proBNP improved the C-statistic (0.67 (95%CI 0.61-0.74, p=0.023)). The categoryless net reclassification improvement for NT-proBNP was 39% (p=0.001), for a history of major CVD 27.2% (p=0.03) and for homocysteine 24.7% (p=0.04). CONCLUSIONS: Among very old subjects with established CVD, NT-proBNP was the strongest risk marker for cardiovascular events and cardiovascular mortality. When estimating risk in secondary prevention in very old age, use of NT-proBNP should be considered.
Peet et al. (Thu,) conducted a cohort in Established cardiovascular disease (n=282). NT-proBNP vs. Traditional cardiovascular risk markers was evaluated on Composite of incident fatal and non-fatal myocardial infarction, incident fatal and non-fatal stroke, or any other cardiovascular mortality (HR 1.7, 95% CI 1.4-2.1). In 85-year-old patients with established cardiovascular disease, NT-proBNP was the strongest predictor of 5-year recurrent cardiovascular events and mortality (HR 1.7).