Lori B Daniels1, Paul Clopton2, Christopher R deFilippi3, Otto A Sanchez4, Hossein Bahrami5, Joao A C Lima6, Russell P Tracy7, David Siscovick8, Alain G Bertoni9, Philip Greenland10, Mary Cushman11, Alan S Maisel12, Michael H Criqui13. 1. Department of Medicine, Division of Cardiovascular Medicine, University of California, San Diego, CA. Electronic address: lbdaniels@ucsd.edu. 2. Department of Medicine, Division of Cardiology, Veterans Affairs San Diego Healthcare System, La Jolla, CA. 3. Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD. 4. School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN. 5. Division of Cardiovascular Medicine, Stanford University, Stanford, CA. 6. Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD. 7. Departments of Pathology and Biochemistry, University of Vermont College of Medicine, Burlington, VT. 8. The New York Academy of Medicine, New York, NY. 9. Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC. 10. Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. 11. Departments of Medicine and Pathology, Cardiovascular Research Institute, University of Vermont, Burlington, VT. 12. Department of Medicine, Division of Cardiovascular Medicine, University of California, San Diego, CA; Department of Medicine, Division of Cardiology, Veterans Affairs San Diego Healthcare System, La Jolla, CA. 13. Department of Family and Preventive Medicine, University of California, San Diego, CA.
Abstract
BACKGROUND: N-terminal-pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (TnT) predict cardiovascular disease (CVD) risk in a variety of populations. Whether their predictive value varies by ethnicity is unknown. We sought to determine whether NT-proBNP and TnT improve prediction of incident coronary heart disease (CHD) and CVD, independent of CVD risk factors, in a multiethnic population; whether NT-proBNP improves prediction compared with the Framingham Risk Score or the Pooled Cohort Risk Equation; and whether a second NT-proBNP further improves prediction. METHODS: Both NT-proBNP and TnT were measured in 5,592 MESA white, black, Hispanic, and Chinese participants (60% nonwhite; mean age 62.3 ± 10.3 years) in 2000 to 2002 and 2004 to 2005. We evaluated adjusted risk of incident CHD and CVD based on baseline and change in biomarker concentration. RESULTS: Participants were followed up through 2011 and incurred 370 CVD events (232 CHD). Concentrations of NT-proBNP and TnT varied by ethnicity. Both NT-proBNP and TnT were associated with an increased risk of events (adjusted hazard ratio [HR] for CHD [95% CI] for fifth quintile vs other 4 quintiles of NT-proBNP, 2.03 [1.50-2.76]; HR for CHD for detectable vs undetectable TnT, 3.95 [2.29-6.81]). N-terminal-pro-B-type natriuretic peptide improved risk prediction and classification compared with the Framingham Risk Score and the Pooled Cohort Risk Equation. Change in NT-proBNP was independently associated with events (HR for CHD per unit increase in ΔlogNT-proBNP, 1.95 [1.16-3.26]). None of the observed associations varied by ethnicity. CONCLUSIONS: Both NT-proBNP and TnT are predictors of incident CHD, independent of established risk factors and ethnicity, in a multiethnic population without known CVD. Change in NT-proBNP may add additional prognostic information.
BACKGROUND: N-terminal-pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (TnT) predict cardiovascular disease (CVD) risk in a variety of populations. Whether their predictive value varies by ethnicity is unknown. We sought to determine whether NT-proBNP and TnT improve prediction of incident coronary heart disease (CHD) and CVD, independent of CVD risk factors, in a multiethnic population; whether NT-proBNP improves prediction compared with the Framingham Risk Score or the Pooled Cohort Risk Equation; and whether a second NT-proBNP further improves prediction. METHODS: Both NT-proBNP and TnT were measured in 5,592 MESA white, black, Hispanic, and Chinese participants (60% nonwhite; mean age 62.3 ± 10.3 years) in 2000 to 2002 and 2004 to 2005. We evaluated adjusted risk of incident CHD and CVD based on baseline and change in biomarker concentration. RESULTS:Participants were followed up through 2011 and incurred 370 CVD events (232 CHD). Concentrations of NT-proBNP and TnT varied by ethnicity. Both NT-proBNP and TnT were associated with an increased risk of events (adjusted hazard ratio [HR] for CHD [95% CI] for fifth quintile vs other 4 quintiles of NT-proBNP, 2.03 [1.50-2.76]; HR for CHD for detectable vs undetectable TnT, 3.95 [2.29-6.81]). N-terminal-pro-B-type natriuretic peptide improved risk prediction and classification compared with the Framingham Risk Score and the Pooled Cohort Risk Equation. Change in NT-proBNP was independently associated with events (HR for CHD per unit increase in ΔlogNT-proBNP, 1.95 [1.16-3.26]). None of the observed associations varied by ethnicity. CONCLUSIONS: Both NT-proBNP and TnT are predictors of incident CHD, independent of established risk factors and ethnicity, in a multiethnic population without known CVD. Change in NT-proBNP may add additional prognostic information.
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