Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis.pdf (465.03 kB)
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Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis.

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journal contribution
posted on 31.07.2018, 08:57 by Natriuretic Peptides Studies Collaboration, Peter Willeit, Stephen Kaptoge, Paul Welsh, Adam S. Butterworth, Rajiv Chowdhury, Sarah A. Spackman, Lisa Pennells, Pei Gao, Stephen Burgess, Daniel F. Freitag, Michael Sweeting, Angela M. Wood, Nancy R. Cook, Suzanne Judd, Stella Trompet, Vijay Nambi, Michael Hecht Olsen, Brendan M. Everett, Frank Kee, Johan Ärnlöv, Veikko Salomaa, Daniel Levy, Jussi Kauhanen, Jari A. Laukkanen, Maryam Kavousi, Toshiharu Ninomiya, Juan-Pablo Casas, Lori B. Daniels, Lars Lind, Caroline N. Kistorp, Jens Rosenberg, Thomas Mueller, Speranza Rubattu, Demosthenes B. Panagiotakos, Oscar H. Franco, James A. de Lemos, Andreas Luchner, Jorge R. Kizer, Stefan Kiechl, Jukka T. Salonen, Salonen S. Goya Wannamethee, Rudolf A. de Boer, Børge Nordestgaard, Jonas Andersson, Torben Jørgensen, Olle Melander, Christie M. Ballantyne, Christopher DeFilippi, Paul M. Ridker, Mary Cushman, Wayne D. Rosamond, Simon G. Thompson, Vilmundur Gudnason, Naveed Sattar, John Danesh, Emanuele Di Angelantonio
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 95 617 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. FUNDING: British Heart Foundation, Austrian Science Fund, UK Medical Research Council, National Institute for Health Research, European Research Council, and European Commission Framework Programme 7.

Funding

The work of the coordinating centre was funded by the UK Medical Research Council (G0800270), British Heart Foundation (SP/09/002), British Heart Foundation Cambridge Cardiovascular Centre of Excellence, National Institute for Health Research Cambridge Biomedical Research Centre, European Research Council, and European Commission Framework Programme 7 (HEALTH-F2–2012–279233). The collaboration's website has compiled a list provided by investigators of some of the funders of the component studies in this analysis. Laboratory measurements were supported by a grant from the Evelyn Trust. Roche donated N-terminal-pro-B-type natriuretic peptide reagents.

History

Citation

Lancet Diabetes Endocrinol, 2016, 4 (10), pp. 840-849

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Health Sciences

Version

VoR (Version of Record)

Published in

Lancet Diabetes Endocrinol

Publisher

Elsevier

issn

2213-8587

eissn

2213-8595

Acceptance date

27/07/2016

Copyright date

2016

Available date

31/07/2018

Publisher version

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(16)30196-6/fulltext

Language

en