Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis

Willeit, P. et al. (2016) Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis. Lancet Diabetes and Endocrinology, 4(10), pp. 840-849. (doi: 10.1016/S2213-8587(16)30196-6) (PMID:27599814) (PMCID:PMC5035346)

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Abstract

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 (NTproBNP) 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 reclassifi cation across predicted 10 year risk categories (ie, <5%, 5% to <7·5%, and ≥7·5%), adding assessment of NT-proBNP concentration to that of conventional risk factors (ie, age, sex, smoking status, systolic blood pressure, history of diabetes, and total and HDL cholesterol concentrations). Primary outcomes were the combination of coronary heart disease and stroke, and the combination of coronary heart disease, stroke, and heart failure. 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 reclassifi cation 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.

Item Type:Articles
Additional Information:This work was written by the Natriuretic Peptides Studies Collaboration. Writing committee members and collaborators are listed at the end of the paper.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Welsh, Dr Paul and Sattar, Professor Naveed
Authors: Willeit, P., Kaptoge, S., Welsh, P., Butterworth, A. S., Chowdhury, R., Spackman, S., Pennells, L., Gao, P., Burgess, S., Freitag, D. F., Sweeting, M., Wood, A. M., Cook, N. R., Judd, S., Trompet, S., Nambi, V., Olsen, M. H., Everett, B. M., Kee, F., Ärnlöv, J., Levy, D., Kauhanen, J., Laukkanen, J. A., Kavousi, M., Ninomiya, T., Casas, J.-P., Daniels, L. B., Lind, L., Kistorp, C. N., Rosenberg, J., Mueller, T., Rubattu, S., Panagiotakos, D. B., Franco, O. H., de Lemos, J. A., Luchner, A., Kizer, J. R., Kiechl, S., Salonen, J. T., Wannamethee, S. G., de Boer, R. A., Nordestgaard, B. G., Andersson, J., Jørgensen, T., Melander, O., Ballantyne, C. M., DeFilippi, C., Ridker, P. M., Cushman, M., Rosamond, W. D., Thompson, S. G., Gudnason, V., Sattar, N., Danesh, J., and Di Angelantonio, E.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Lancet Diabetes and Endocrinology
Publisher:Elsevier
ISSN:2213-8587
ISSN (Online):2213-8595
Published Online:03 September 2016
Copyright Holders:Copyright © 2016 The Authors
First Published:First published in Lancet Diabetes and Endocrinology 4(10): 840-849
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
612031Cardiac biomarkers and CVD risk screening: a cost-effective public health measure?Paul WelshBritish Heart Foundation (BHF)FS/12/62/29889RI CARDIOVASCULAR & MEDICAL SCIENCES