TY - JOUR
T1 - Natriuretic peptides and integrated risk assessment for cardiovascular disease
T2 - an individual-participant-data meta-analysis
AU - Willeit, Peter
AU - Kaptoge, Stephen
AU - Welsh, Paul
AU - Butterworth, Adam S.
AU - Chowdhury, Rajiv
AU - Spackman, Sarah A.
AU - Pennells, Lisa
AU - Gao, Pei
AU - Burgess, Stephen
AU - Freitag, Daniel F.
AU - Sweeting, Michael
AU - Wood, Angela M.
AU - Cook, Nancy R.
AU - Judd, Suzanne
AU - Trompet, Stella
AU - Nambi, Vijay
AU - Olsen, Michael Hecht
AU - Everett, Brendan M.
AU - Kee, Frank
AU - Arnlov, Johan
AU - Salomaa, Veikko
AU - Levy, Daniel
AU - Kauhanen, Jussi
AU - Laukkanen, Jari A.
AU - Kavousi, Maryam
AU - Ninomiya, Toshiharu
AU - Casas, Juan-Pablo
AU - Daniels, Lori B.
AU - Lind, Lars
AU - Kistorp, Caroline N.
AU - Rosenberg, Jens
AU - Mueller, Thomas
AU - Rubattu, Speranza
AU - Panagiotakos, Demosthenes B.
AU - Franco, Oscar H.
AU - de Lemos, James A.
AU - Luchner, Andreas
AU - Kizer, Jorge R.
AU - Kiechl, Stefan
AU - Salonen, Jukka T.
AU - Wannamethee, S. Goya
AU - de Boer, Rudolf A.
AU - Nordestgaard, Borge G.
AU - Andersson, Jonas
AU - Jorgensen, Torben
AU - Melander, Olle
AU - Ballantyne, Christie M.
AU - DeFilippi, Christopher
AU - Ridker, Paul M.
AU - Cushman, Mary
AU - Natriuretic Peptides Studies Coll
AU - Sattar, Naveed
AU - Danesh, John
AU - Di Angelantonio, Emanuele
AU - Bakker, Stephan
PY - 2016/10
Y1 - 2016/10
N2 - 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, = 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
AB - 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, = 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
KW - C-REACTIVE PROTEIN
KW - ASSOCIATION TASK-FORCE
KW - CORONARY-HEART-DISEASE
KW - GENERAL-POPULATION
KW - NT-PROBNP
KW - COST-EFFECTIVENESS
KW - TROPONIN-T
KW - PRACTICE GUIDELINES
KW - COLLABORATIVE CARE
KW - ACCF/AHA GUIDELINE
U2 - 10.1016/S2213-8587(16)30196-6
DO - 10.1016/S2213-8587(16)30196-6
M3 - Article
SN - 2213-8587
VL - 4
SP - 840
EP - 849
JO - Lancet Diabetes & Endocrinology
JF - Lancet Diabetes & Endocrinology
IS - 10
ER -