N-Terminal Pro-B-Type Natriuretic Peptide and the Prediction of Primary Cardiovascular Events: Results From 15-Year Follow-Up of WOSCOPS

Study Questions:

Are N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels useful in the prediction of primary cardiovascular disease (CVD) events?

Methods:

Baseline NT-proBNP levels were measured in 4,801 men and correlated to the risk of CVD over 15 years, during which 1,690 experienced CVD events.

Results:

NT-proBNP levels were associated with an increased risk of CVD (hazard ratio [HR], 1.17 per standard deviation increase in log NT-proBNP) after adjustment for CV risk factors plus C-reactive protein (CRP) levels. NT-proBNP was more strongly related to the risk of fatal (HR, 1.34) than nonfatal CVD (HR, 1.17; p = 0.022). The addition of NT-proBNP to traditional risk factors improved the C-index (+0.013; p < 0.001) and the continuous net reclassification index improved with the addition of NT-proBNP by 19.8% compared with 9.8% with the addition of CRP. NT-proBNP correctly reclassified 14.7% of events, whereas CRP correctly reclassified 3.4% of events.

Conclusions:

The authors concluded that NT-proBNP predicts CVD events in men without previous clinical evidence of vascular disease. NT-proBNP also provides moderate risk discrimination, in excess of that provided by the measurement of CRP.

Perspective:

Several studies have shown that a variety of biomarkers, including NT-proBNP, may be useful in stratifying patients for risk of CV complications. However, the predictive utility of NT-proBNP in the primary prevention setting is unclear. The current study demonstrates that NT-proBNP is even more useful than CRP for discriminating CV risk in a primary prevention study, and may be particularly useful for predicting fatal CV events. Whether use of NT-proBNP will prove to be cost-effective in guiding management strategies that lead to improved outcomes will require further study.

Clinical Topics: Dyslipidemia, Homozygous Familial Hypercholesterolemia

Keywords: Natriuretic Peptides, Biological Markers, Scotland, Middle Aged, Cardiovascular Diseases, Hypercholesterolemia


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