|Title||Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis.|
|Publication Type||Journal Article|
|Year of Publication||2016|
|Authors||Willeit P, Kaptoge S, Welsh P, Butterworth A, Chowdhury, iv R, Spackman S, Pennells L, Gao P, Burgess S, Freitag D, Sweeting M, Wood A, Cook N, Judd S, Trompet S, Nambi V, Olsen M, Everett B, Kee F, rnlöv JÄ, Salomaa V, Levy D, Kauhanen J, Laukkanen J, Kavousi M, Ninomiya T, Casas J-P, Daniels L, Lind L, Kistorp C, Rosenberg J, Mueller T, Rubattu S, Panagiotakos D, Franco O, de Lemos J, Luchner A, Kizer J, Kiechl S, Salonen J, S Wannamethee G, de Boer R, Nordestgaard B, Andersson J, Jørgensen T, Melander O, Ballantyne CM, deFilippi C, Ridker P, Cushman M, Rosamond WD, Thompson S, Gudnason V, Sattar N, Danesh J|
|Secondary Authors||Di Angelantonio E|
|Journal||Lancet Diabetes Endocrinol|
|Date Published||2016 10|
|Keywords||Aged, Biomarkers, Cardiovascular Diseases, Female, Humans, Male, Middle Aged, Natriuretic Peptide, Brain, Peptide Fragments, Prospective Studies, Risk Assessment|
BACKGROUND: Guidelines for primary prevention of cardiovascular diseases focus on prediction of coronary heart disease and stroke. We assessed whether or not measurement of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) concentration could enable a more integrated approach than at present by predicting heart failure and enhancing coronary heart disease and stroke risk assessment.
METHODS: In this individual-participant-data meta-analysis, we generated and harmonised individual-participant data from relevant prospective studies via both de-novo NT-proBNP concentration measurement of stored samples and collection of data from studies identified through a systematic search of the literature (PubMed, Scientific Citation Index Expanded, and Embase) for articles published up to Sept 4, 2014, using search terms related to natriuretic peptide family members and the primary outcomes, with no language restrictions. We calculated risk ratios and measures of risk discrimination and reclassification across predicted 10 year risk categories (ie,
FINDINGS: We recorded 5500 coronary heart disease, 4002 stroke, and 2212 heart failure outcomes among 95 617 participants without a history of cardiovascular disease in 40 prospective studies. Risk ratios (for a comparison of the top third vs bottom third of NT-proBNP concentrations, adjusted for conventional risk factors) were 1·76 (95% CI 1·56-1·98) for the combination of coronary heart disease and stroke and 2·00 (1·77-2·26) for the combination of coronary heart disease, stroke, and heart failure. Addition of information about NT-proBNP concentration to a model containing conventional risk factors was associated with a C-index increase of 0·012 (0·010-0·014) and a net reclassification improvement of 0·027 (0·019-0·036) for the combination of coronary heart disease and stroke and a C-index increase of 0·019 (0·016-0·022) and a net reclassification improvement of 0·028 (0·019-0·038) for the combination of coronary heart disease, stroke, and heart failure.
INTERPRETATION: In people without baseline cardiovascular disease, NT-proBNP concentration assessment strongly predicted first-onset heart failure and augmented coronary heart disease and stroke prediction, suggesting that NT-proBNP concentration assessment could be used to integrate heart failure into cardiovascular disease primary prevention.
FUNDING: British Heart Foundation, Austrian Science Fund, UK Medical Research Council, National Institute for Health Research, European Research Council, and European Commission Framework Programme 7.
|Alternate Journal||Lancet Diabetes Endocrinol|
|PubMed Central ID||PMC5035346|
|Grant List||FS/10/37/28413 / / British Heart Foundation / United Kingdom |
FS/12/62/29889 / / British Heart Foundation / United Kingdom
PG/13/66/30442 / / British Heart Foundation / United Kingdom
/ / Medical Research Council / United Kingdom