N-terminal pro-brain natriuretic peptide is a more useful predictor of cardiovascular disease risk than C-reactive protein in older men with and without pre-existing cardiovascular disease

S. Goya Wannamethee, Paul Welsh, Gordon D. Lowe, Vilmundur Gudnason, Emanuele Di Angelantonio, Lucy Lennon, Ann Rumley, Peter H. Whincup, Naveed Sattar

Research output: Contribution to journalArticlepeer-review

65 Citations (Scopus)

Abstract

Objectives: We aimed to compare the predictive capabilities of N-terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) for risk of cardiovascular disease (CVD) in older men with and without pre-existing CVD. Background: The clinical utility of NT-proBNP in CVD risk stratification in the general population remains unclear. Methods: A prospective study of 3,649 men age 60 to 79 years were followed for a mean of 9 years during which there were 608 major CVD events (major fatal and nonfatal coronary heart disease, stroke, and CVD death). Results: NT-proBNP was significantly associated with risk of all major CVD outcomes after adjustment for CV risk factors in both men with and without CVD. The adjusted standardized hazard ratios for CVD events in those without pre-existing CVD and those with pre-existing CVD were 1.49 (95% confidence interval [CI]: 1.33 to 1.65) and 1.52 (95% CI: 1.33 to 1.75), respectively. CRP was associated with CVD outcomes only in men without pre-existing CVD (adjusted standardized hazard ratios: 1.22 [95% CI: 1.10 to 1.34] and 1.00 [95% CI: 0.86 to 1.38], respectively). NT-proBNP was more strongly associated with CVD outcome than CRP, particularly among those with pre-existing CVD. Inclusion of NT-proBNP in a Framingham-based model yielded significant improvement in C-statistics in both men with and without CVD and resulted in a net reclassification improvement of 8.8% (p = 0.0009) and 8.2% (p < 0.05), respectively, for major CVD events. Inclusion of CRP in the Framingham-based model did not improve prediction in either group (net reclassification improvement 3.8% and 0.6%, respectively). Conclusions: NT-proBNP, but not CRP, improved prediction of major CVD events in older men with and without pre-existing CVD.

Original languageEnglish
Pages (from-to)56-64
Number of pages9
JournalJournal of the American College of Cardiology
Volume58
Issue number1
DOIs
Publication statusPublished - 28 Jun 2011

Bibliographical note

Funding Information:
The British Regional Heart Study is a BHF research group and receives support from the BHF Programme grant ( RG/08/013/25942 ). Dr. Welsh is supported by BHF fellowship FS/10/005/28147. The authors have reported that they have no relationships to disclose.

Other keywords

  • C-reactive protein
  • cardiovascular disease
  • epidemiology
  • NT-proBNP

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