Welsh, P. , Doolin, O., Willeit, P., Packard, C. , Macfarlane, P., Cobbe, S., Gudnason, V., Di Angelantonio, E., Ford, I. and Sattar, N. (2013) N-terminal pro-B-type natriuretic peptide and the prediction of primary cardiovascular events: results from 15-year follow-up of WOSCOPS. European Heart Journal, 34(6), pp. 443-450. (doi: 10.1093/eurheartj/ehs239)
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Abstract
<b>Aims:</b>To test whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) was independently associated with, and improved the prediction of, cardiovascular disease (CVD) in a primary prevention cohort. <b>Methods and results:</b> In the West of Scotland Coronary Prevention Study (WOSCOPS), a cohort of middle-aged men with hypercholesterolaemia at a moderate risk of CVD, we related the baseline NT-proBNP (geometric mean 28 pg/mL) in 4801 men to the risk of CVD over 15 years during which 1690 experienced CVD events. Taking into account the competing risk of non-CVD death, NT-proBNP was associated with an increased risk of all CVD [HR: 1.17 (95% CI: 1.11–1.23) per standard deviation increase in log NT-proBNP] after adjustment for classical and clinical cardiovascular risk factors plus C-reactive protein. N-terminal pro-B-type natriuretic peptide was more strongly related to the risk of fatal [HR: 1.34 (95% CI: 1.19–1.52)] than non-fatal CVD [HR: 1.17 (95% CI: 1.10–1.24)] (P= 0.022). The addition of NT-proBNP to traditional risk factors improved the C-index (+0.013; P < 0.001). The continuous net reclassification index improved with the addition of NT-proBNP by 19.8% (95% CI: 13.6–25.9%) compared with 9.8% (95% CI: 4.2–15.6%) with the addition of C-reactive protein. N-terminal pro-B-type natriuretic peptide correctly reclassified 14.7% of events, whereas C-reactive protein correctly reclassified 3.4% of events. Results were similar in the 4128 men without evidence of angina, nitrate prescription, minor ECG abnormalities, or prior cerebrovascular disease. <b>Conclusion:</b> N-terminal pro-B-type natriuretic peptide predicts CVD events in men without clinical evidence of CHD, angina, or history of stroke, and appears related more strongly to the risk for fatal events. N-terminal pro-B-type natriuretic peptide also provides moderate risk discrimination, in excess of that provided by the measurement of C-reactive protein.
| Item Type: | Articles |
|---|---|
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Macfarlane, Professor Peter and Welsh, Professor Paul and Doolin, Ms Orla and Ford, Professor Ian and Cobbe, Professor Stuart and Packard, Professor Chris and Sattar, Professor Naveed |
| Authors: | Welsh, P., Doolin, O., Willeit, P., Packard, C., Macfarlane, P., Cobbe, S., Gudnason, V., Di Angelantonio, E., Ford, I., and Sattar, N. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
| Journal Name: | European Heart Journal |
| Journal Abbr.: | Eur. Heart J. |
| Publisher: | Oxford University Press on behalf of European Society of Cardiology |
| ISSN: | 0195-668X |
| ISSN (Online): | 1522-9645 |
| Published Online: | 31 August 2012 |
| Copyright Holders: | Copyright © 2012 The Authors |
| First Published: | First published in European Heart Journal 34(6):443-450 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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