TY - JOUR
T1 - B-type natriuretic peptide and C-reactive protein in the prediction of atrial fibrillation risk
T2 - The CHARGE-AF Consortium of community-based cohort studies
AU - Sinner, Moritz F.
AU - Stepas, Katherine A.
AU - Moser, Carlee B.
AU - Krijthe, Bouwe P.
AU - Aspelund, Thor
AU - Sotoodehnia, Nona
AU - Fontes, João D.
AU - Janssens, A. Cecile J.W.
AU - Kronmal, Richard A.
AU - Magnani, Jared W.
AU - Witteman, Jacqueline C.
AU - Chamberlain, Alanna M.
AU - Lubitz, Steven A.
AU - Schnabel, Renate B.
AU - Vasan, Ramachandran S.
AU - Wang, Thomas J.
AU - Agarwal, Sunil K.
AU - McManus, David D.
AU - Franco, Oscar H.
AU - Yin, Xiaoyan
AU - Larson, Martin G.
AU - Burke, Gregory L.
AU - Launer, Lenore J.
AU - Hofman, Albert
AU - Levy, Daniel
AU - Gottdiener, John S.
AU - Kääb, Stefan
AU - Couper, David
AU - Harris, Tamara B.
AU - Astor, Brad C.
AU - Ballantyne, Christie M.
AU - Hoogeveen, Ron C.
AU - Arai, Andrew E.
AU - Soliman, Elsayed Z.
AU - Ellinor, Patrick T.
AU - Stricker, Bruno H.C.
AU - Gudnason, Vilmundur
AU - Heckbert, Susan R.
AU - Pencina, Michael J.
AU - Benjamin, Emelia J.
AU - Alonso, Alvaro
N1 - Funding Information:
This work was supported by the US National Institutes of Health, Bethesda, MD [1RC1HL101056].
Funding Information:
This work was supported by the US National Institutes of Health, Bethesda, MD [1RC1HL101056]. Details on additional funding are available in the supplemental material.
PY - 2014/10
Y1 - 2014/10
N2 - Aims: B-type natriuretic peptide (BNP) and C-reactive protein (CRP) predict atrial fibrillation (AF) risk. However, their risk stratification abilities in the broad community remain uncertain.We sought to improve risk stratification for AF using biomarker information. Methods and results: We ascertained AF incidence in 18 556 Whites and African Americans from the Atherosclerosis Risk in Communities Study (ARIC, n=10 675), Cardiovascular Health Study (CHS, n = 5043), and Framingham Heart Study (FHS, n = 2838), followed for 5 years (prediction horizon).We added BNP (ARIC/CHS: N-terminal pro-B-type natriuretic peptide; FHS: BNP), CRP, or both to a previously reported AF risk score, and assessed model calibration and predictive ability [Cstatistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI)]. We replicated models in two independent European cohorts: Age, Gene/Environment Susceptibility Reykjavik Study (AGES), n = 4467; Rotterdam Study (RS), n = 3203. B-type natriuretic peptide and CRP were significantly associated with AF incidence (n = 1186): hazard ratio per 1-SD ln-transformed biomarker 1.66 [95% confidence interval (CI), 1.56- 1.76], P < 0.0001 and 1.18 (95% CI, 1.11-1.25), P < 0.0001, respectively. Model calibration was sufficient (BNP, χ2 = 17.0; CRP, χ2 = 10.5; BNP and CRP, χ2 = 13.1). B-type natriuretic peptide improved the C-statistic from 0.765 to 0.790, yielded an IDI of 0.027 (95% CI, 0.022-0.032), a relative IDI of 41.5%, and a continuous NRI of 0.389 (95% CI, 0.322-0.455). The predictive ability of CRP was limited (C-statistic increment 0.003). B-type natriuretic peptide consistently improved prediction in AGES and RS. Conclusion: B-type natriuretic peptide, not CRP, substantially improved AF risk prediction beyond clinical factors in an independently replicated, heterogeneous population. B-type natriuretic peptide may serve as a benchmark to evaluate novel putative AF risk biomarkers. Published by Oxford University Press on behalf of the European Society of Cardiology 2014.
AB - Aims: B-type natriuretic peptide (BNP) and C-reactive protein (CRP) predict atrial fibrillation (AF) risk. However, their risk stratification abilities in the broad community remain uncertain.We sought to improve risk stratification for AF using biomarker information. Methods and results: We ascertained AF incidence in 18 556 Whites and African Americans from the Atherosclerosis Risk in Communities Study (ARIC, n=10 675), Cardiovascular Health Study (CHS, n = 5043), and Framingham Heart Study (FHS, n = 2838), followed for 5 years (prediction horizon).We added BNP (ARIC/CHS: N-terminal pro-B-type natriuretic peptide; FHS: BNP), CRP, or both to a previously reported AF risk score, and assessed model calibration and predictive ability [Cstatistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI)]. We replicated models in two independent European cohorts: Age, Gene/Environment Susceptibility Reykjavik Study (AGES), n = 4467; Rotterdam Study (RS), n = 3203. B-type natriuretic peptide and CRP were significantly associated with AF incidence (n = 1186): hazard ratio per 1-SD ln-transformed biomarker 1.66 [95% confidence interval (CI), 1.56- 1.76], P < 0.0001 and 1.18 (95% CI, 1.11-1.25), P < 0.0001, respectively. Model calibration was sufficient (BNP, χ2 = 17.0; CRP, χ2 = 10.5; BNP and CRP, χ2 = 13.1). B-type natriuretic peptide improved the C-statistic from 0.765 to 0.790, yielded an IDI of 0.027 (95% CI, 0.022-0.032), a relative IDI of 41.5%, and a continuous NRI of 0.389 (95% CI, 0.322-0.455). The predictive ability of CRP was limited (C-statistic increment 0.003). B-type natriuretic peptide consistently improved prediction in AGES and RS. Conclusion: B-type natriuretic peptide, not CRP, substantially improved AF risk prediction beyond clinical factors in an independently replicated, heterogeneous population. B-type natriuretic peptide may serve as a benchmark to evaluate novel putative AF risk biomarkers. Published by Oxford University Press on behalf of the European Society of Cardiology 2014.
KW - Atrial fibrillation
KW - B-type natriuretic peptide
KW - Biomarker
KW - C-reactive protein
KW - Epidemiology
KW - Risk prediction
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U2 - 10.1093/europace/euu175
DO - 10.1093/europace/euu175
M3 - Article
C2 - 25037055
AN - SCOPUS:84964316222
SN - 1099-5129
VL - 16
SP - 1426
EP - 1433
JO - Europace
JF - Europace
IS - 10
ER -