Comparative Impact of Multiple Biomarkers and N-Terminal Pro-Brain Natriuretic Peptide in the Context of Conventional Risk Factors for the Prediction of Recurrent Cardiovascular Events in the Heart Outcomes Prevention Evaluation (HOPE) Study
- 18 July 2006
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 114 (3), 201-208
- https://doi.org/10.1161/circulationaha.105.590927
Abstract
Background— Individual markers of inflammation may add incremental predictive value in the context of conventionally available risk factors. We evaluated the ability of 9 inflammatory biomarkers, microalbuminuria, and N-terminal pro-brain natriuretic peptide (Nt-proBNP) to improve cardiovascular risk prediction beyond that obtained from traditional risk factors in a secondary-prevention population. Methods and Results— We measured biomarkers representing the acute-phase reaction (C-reactive protein, fibrinogen, and interleukin-6), proinflammatory pathways (soluble tumor necrosis factor receptor-1 and -2, soluble interleukin-1 receptor antagonist, and interleukin-18), endothelial activation (soluble vascular adhesion molecule-1 and soluble intercellular adhesion molecule-1), Nt-proBNP, and microalbuminuria in 3199 study individuals of the Heart Outcomes Prevention Evaluation (HOPE) Study and assessed their association with risk of myocardial infarction, stroke, or cardiovascular death (primary outcome, n=501) over 4.5 years of follow-up. In a backward Cox regression procedure that included risk factors and biomarkers, Nt-proBNP (hazard ratio [HR] 1.72 per increment SD, 95% CI 1.39 to 2.12; P P =0.0003), microalbuminuria (HR 1.55, 95% CI 1.22 to 1.98; P =0.0004), soluble interleukin-1 receptor antagonist (HR 1.30, 95% CI 1.05 to 1.61; P =0.02), and fibrinogen (HR 1.31, 95% CI 1.05 to 1.62; P =0.02) remained significantly related to the primary outcome. Only inclusion of Nt-proBNP provided incremental information above that obtained by models of traditional risk factors. Conclusions— Although levels of various inflammatory biomarkers are significantly related to future cardiovascular risk, their incremental predictive value is modest. A model consisting of simple traditional risk factors and Nt-proBNP provided the best clinical prediction in the secondary-prevention population.Keywords
This publication has 27 references indexed in Scilit:
- Inflammatory Markers and the Risk of Coronary Heart Disease in Men and WomenNew England Journal of Medicine, 2004
- Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control studyThe Lancet, 2004
- Inflammation as a Cardiovascular Risk FactorCirculation, 2004
- Serum Levels of the Interleukin-1 Receptor Family Member ST2 Predict Mortality and Clinical Outcome in Acute Myocardial InfarctionCirculation, 2004
- Plasma Natriuretic Peptide Levels and the Risk of Cardiovascular Events and DeathNew England Journal of Medicine, 2004
- Interleukin-18 and the Risk of Coronary Heart Disease in European MenCirculation, 2003
- Inflammatory Markers and Onset of Cardiovascular EventsCirculation, 2003
- MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebocontrolled trialThe Lancet, 2002
- Interleukin-18 Is a Strong Predictor of Cardiovascular Death in Stable and Unstable AnginaCirculation, 2002
- The Prognostic Value of B-Type Natriuretic Peptide in Patients with Acute Coronary SyndromesNew England Journal of Medicine, 2001