N-terminal pro-brain natriuretic peptide, but not high sensitivity C-reactive protein, improves cardiovascular risk prediction in the general population

被引:112
作者
Olsen, Michael H. [1 ]
Hansen, Tine W.
Christensen, Marina K.
Gustafsson, Finn
Rasmussen, Susanne
Wachtell, Kristian
Ibsen, Hans
Torp-Pedersen, Christian
Hildebrandt, Per R.
机构
[1] Glostrup Univ Hosp, Res Ctr Prevent & Hlth, Dept Clin Physiol & Nucl Med, DK-2600 Glostrup, Denmark
[2] Rigshosp, Dept Cardiol, Copenhagen, Denmark
[3] Frederiksberg Univ Hosp, Dept Cardiol, Frederiksberg, Denmark
[4] Glostrup Univ Hosp, Dept Internal Med, DK-2600 Glostrup, Denmark
[5] Bispebjerg Hosp, Dept Cardiol, Copenhagen, Denmark
关键词
N-terminat pro-brain natriuretic peptide; high sensitivity C-reactive protein; albuminuria; cardiovascular risk factors; population survey; left ventricular hypertrophy; left ventricutar systolic function; pulse wave velocity; prognosis;
D O I
10.1093/eurheartj/ehl448
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aim Serum N-terminal pro-brain natriuretic peptide (Nt-proBNP), high sensitivity (hs)-C-reactive protein, and urine albumin/creatinine ratio (UACR) are cardiovascular (CV) risk markers in the general population. The aim of this study was to determine whether they predicted CV events independently of established CV risk factors and whether they did so in an additive fashion. Methods and results In a population-based sample of 2656 individuals, 41, 51, 61, and 71 years old, we measured UACR, serum Nt-proBNP, hs-C-reactive protein, insulin, lipids and plasma glucose, clinic blood pressures, body composition, left ventricular (LV) mass index, and ejection fraction (EF) by echocardiography and pulse wave velocity. During the following 9.4 years, the combined CV endpoint (CEP) of CV death (136), non-fatal stroke, or non-fatal myocardial infarction occurred in 219 subjects. After adjustment for established CV risk factors using Cox-regression analyses, CEP and CV death were predicted by log(Nt-proBNP)/SD [hazard ratio (HR) = 1.58 and HR = 1.80, both P < 0.001] and by tog(UACR)/SD (HR = 1.44 and HR = 1.52, both P < 0.001) in an additive fashion, but not by log(hs-C- reactive protein)/SD (HR = 1.17, P = 0.06 and HIR = 1.13, NS). CV risk functions were constructed on the basis of Cox-regression analyses. Inclusion of Nt-proBNP and UACR did not increase the area under the receiver-operating characteristic plots. Conclusion Serum Nt-proBNP and UACR, but not hs-C-reactive protein, predicted CV events after adjustment for established CV risk factors including LV EF and relative wall thickness. However, more studies in relevant subgroups are needed before Nt-proBNP and UACR can be recommended for risk prediction in the general population to select subjects for primary prevention.
引用
收藏
页码:1374 / 1381
页数:8
相关论文
共 27 条
[1]   Urinary albumin excretion - An independent predictor of ischemic heart disease [J].
Borch-Johnsen, K ;
Feldt-Rasmussen, B ;
Strandgaard, S ;
Schroll, M ;
Jensen, JS .
ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, 1999, 19 (08) :1992-1997
[2]   Estimation of ten-year risk of fatal cardiovascular disease in Europe:: the SCORE project [J].
Conroy, RM ;
Pyörälä, K ;
Fitzgerald, AP ;
Sans, S ;
Menotti, A ;
De Backer, G ;
De Bacquer, D ;
Ducimetière, P ;
Jousilahti, P ;
Keil, U ;
Njolstad, I ;
Oganov, RG ;
Thomsen, T ;
Tunstall-Pedoe, H ;
Tverdal, A ;
Wedel, H ;
Whincup, P ;
Wilhelmsen, L ;
Graham, IM .
EUROPEAN HEART JOURNAL, 2003, 24 (11) :987-1003
[3]   C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease [J].
Danesh, J ;
Wheeler, JG ;
Hirschfield, GM ;
Eda, S ;
Eiriksdottir, G ;
Rumley, A ;
Lowe, GDO ;
Pepys, MB ;
Gudnason, V .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 350 (14) :1387-1397
[4]   Increasing prevalence of diabetes mellitus and impaired glucose tolerance among 60-year-old Danes [J].
Drivsholm, T ;
Ibsen, H ;
Schroll, M ;
Davidsen, M ;
Borch-Johnsen, K .
DIABETIC MEDICINE, 2001, 18 (02) :126-132
[5]   Primary prevention of coronary heart disease: Guidance from Framingham - A statement for healthcare professionals from the AHA task force on risk reduction [J].
Grundy, SM ;
Balady, GJ ;
Criqui, MH ;
Fletcher, G ;
Greenland, P ;
Hiratzka, LF ;
Houston-Miller, N ;
Kris-Etherton, P ;
Krumholz, HM ;
LaRosa, J ;
Ockene, IS ;
Pearson, TA ;
Reed, J ;
Washington, R ;
Smith, SC .
CIRCULATION, 1998, 97 (18) :1876-1887
[6]  
Gustafsson Finn, 2003, HeartDrug, V3, P141, DOI 10.1159/000073839
[7]   Relation between insulin and aortic stiffness: a population-based study [J].
Hansen, TW ;
Jeppesen, J ;
Rasmussen, S ;
Ibsen, H ;
Torp-Pedersen, C .
JOURNAL OF HUMAN HYPERTENSION, 2004, 18 (01) :1-7
[8]   Does albuminuria predict cardiovascular outcome on treatment with losartan versus atenolol in hypertension with left ventricular hypertrophy?: A LIFE substudy [J].
Ibsen, H ;
Wachtell, K ;
Olsen, MH ;
Borch-Johnsen, K ;
Lindholm, LH ;
Mogensen, CE ;
Dahlöf, B ;
Devereux, RB ;
de Faire, U ;
Fyhrquist, F ;
Julius, S ;
Kjeldsen, SE ;
Lederballe-Pedersen, O ;
Nieminen, MS ;
Omvik, P ;
Oparil, S ;
Wan, Y .
JOURNAL OF HYPERTENSION, 2004, 22 (09) :1805-1811
[9]   Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients -: Losartan intervention for endpoint reduction in hypertension study [J].
Ibsen, H ;
Olsen, MH ;
Wachtell, K ;
Borch-Johnsen, K ;
Lindholm, LH ;
Mogensen, CE ;
Dahlöf, B ;
Devereux, RB ;
de Faire, U ;
Fyhrquist, F ;
Julius, S ;
Kjeldsen, SE ;
Lederballe-Pedersen, O ;
Nieminen, MS ;
Omvik, P ;
Oparil, S ;
Wan, Y .
HYPERTENSION, 2005, 45 (02) :198-202
[10]   MICROALBUMINURIA REFLECTS A GENERALIZED TRANSVASCULAR ALBUMIN LEAKINESS IN CLINICALLY HEALTHY-SUBJECTS [J].
JENSEN, JS ;
BORCHJOHNSEN, K ;
JENSEN, G ;
FELDTRASMUSSEN, B .
CLINICAL SCIENCE, 1995, 88 (06) :629-633