Willeit, Peter and Kaptoge, Stephen and Welsh, Paul and Butterworth, Adam S. and Chowdhury, Rajiv and Spackman, Sarah A. and Pennells, Lisa and Gao, Pei and Burgess, Stephen and Freitag, Daniel F. and Sweeting, Michael and Wood, Angela M. and Cook, Nancy R. and Judd, Suzanne and Trompet, Stella and Nambi, Vijay and Olsen, Michael Hecht and Everett, Brendan M. and Kee, Frank and Arnlov, Johan and Salomaa, Veikko and Levy, Daniel and Kauhanen, Jussi and Laukkanen, Jari A. and Kavousi, Maryam and Ninomiya, Toshiharu and Casas, Juan-Pablo and Daniels, Lori B. and Lind, Lars and Kistorp, Caroline N. and Rosenberg, Jens and Mueller, Thomas and Rubattu, Speranza and Panagiotakos, Demosthenes B. and Franco, Oscar H. and de Lemos, James A. and Luchner, Andreas and Kizer, Jorge R. and Kiechl, Stefan and Salonen, Jukka T. and Wannamethee, S. Goya and de Boer, Rudolf A. and Nordestgaard, Borge G. and Andersson, Jonas and Jorgensen, Torben and Melander, Olle and Ballantyne, Christie M. and DeFilippi, Christopher and Ridker, Paul M. and Cushman, Mary and Rosamond, Wayne D. and Thompson, Simon G. and Gudnason, Vilmundur and Sattar, Naveed and Danesh, John and Di Angelantonio, Emanuele (2016) Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis. LANCET DIABETES & ENDOCRINOLOGY, 4 (10). pp. 840-849. ISSN 2213-8587,
Full text not available from this repository.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 (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, <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 95617 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. Copyright (C) 2016 The Author(s). Published by Elsevier Ltd
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | C-REACTIVE PROTEIN; ASSOCIATION TASK-FORCE; CORONARY-HEART-DISEASE; GENERAL-POPULATION; NT-PROBNP; COST-EFFECTIVENESS; TROPONIN-T; PRACTICE GUIDELINES; COLLABORATIVE CARE; ACCF/AHA GUIDELINE; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 08 Apr 2019 08:54 |
| Last Modified: | 08 Apr 2019 08:54 |
| URI: | https://pred.uni-regensburg.de/id/eprint/4122 |
Actions (login required)
 |
View Item |
