NT-proBNP is associated with coronary heart disease risk in healthy older women but fails to enhance prediction beyond established risk factors: Results from the British Women's Heart and Health Study

Sattar, N. , Welsh, P. , Sarwar, N., Danesh, J., Di Angelantonio, E., Gudnason, V., Smith, G. D., Ebrahim, S. and Lawlor, D. A. (2010) NT-proBNP is associated with coronary heart disease risk in healthy older women but fails to enhance prediction beyond established risk factors: Results from the British Women's Heart and Health Study. Atherosclerosis, 209(1), pp. 295-299. (doi:10.1016/j.atherosclerosis.2009.09.016)

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Abstract

Objective: Limited evidence suggests NT-proBNP improves prediction of coronary heart disease (CHD) events but further data are needed, especially in people without pre-existing CHD and in women. Methods: We measured NT-proBNP in serum from 162 women with incident CHD events and 1226 controls (60-79 years) in a case-control study nested within the prospective British Women's Heart and Health Study. All cases and controls were free from CHD at baseline. We related NT-proBNP to CHD event risk, and determined to what extent NT-proBNP enhanced CHD risk prediction beyond established risk factors. Results: The odds ratio for CHD per 1 standard deviation increase in loge NT-proBNP was 1.37 (95% CI: 1.13-1.68) in analyses adjusted for established CHD risk factors, social class, CRP and insulin. However, addition of loge NT-proBNP did not improve the discrimination of a prediction model including age, social class, smoking, physical activity, lipids, fasting glucose, waist: hip ratio, hypertension, statin and aspirin use, nor a standard Framingham risk score model; area under the receiver operator curve for the former model increased from 0.676 to 0.687 on inclusion of NT-proBNP (p = 0.3). Furthermore, adding NT-proBNP did not improve calibration of a prediction model containing established risk factors, nor did inclusion more appropriately re-classify participants in relation to their final outcome. Findings were similar (independent associations, but no prediction improvement) for fasting insulin and CRP. Conclusion: These results caution against use of NT-proBNP for CHD risk prediction in healthy women and suggest a need for larger studies in both genders to resolve outstanding uncertainties. (C) 2009 Elsevier Ireland Ltd. All rights reserved

Item Type:Articles
Keywords:ADIPONECTIN AGE ASPIRIN ASSOCIATION BRAIN NATRIURETIC PEPTIDE C-REACTIVE PROTEIN CALIBRATION CARDIOVASCULAR EVENTS Case-control study Coronary heart disease CORONARY-HEART-DISEASE DEATH DISEASE Epidemiology EVENTS HEALTH heart disease HEART-DISEASE hypertension INCREASE insulin METABOLIC SYNDROME MODEL MORTALITY MULTIPLE BIOMARKERS Natriuretic peptides NT-proBNP outcome PEOPLE physical activity PHYSICAL-ACTIVITY PREDICTION Prospective RISK risk factors RISK-FACTOR RISK-FACTORS SCORE SERUM SMOKING WOMEN
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Welsh, Dr Paul and Sattar, Professor Naveed
Authors: Sattar, N., Welsh, P., Sarwar, N., Danesh, J., Di Angelantonio, E., Gudnason, V., Smith, G. D., Ebrahim, S., and Lawlor, D. A.
College/School:College of Medical Veterinary and Life Sciences
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Atherosclerosis
ISSN:0021-9150

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