Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis

Vijay Nambi, Christie M. Ballantyne, Ron C. Hoogeveen, Sunil K. Agarwal, Demosthenes B. Panagiotakos, S. Goya Wannamethee, Peter H. Whincup, Stefan Kiechl, Johann Willeit, Georg Schett, Peter Santer, Peter Willeit, Juan Pablo Casas, Debbie A. Lawlor, Christopher DeFilippi, Richard A. Kronmal, Bruce M. Psaty, Mary Cushman, Børge G. Nordestgaard, Michael Hecht OlsenTorben Jørgensen, James A. de Lemos, Darren K. McGuire, Sandeep R. Das, Mark H. Drazner, Veikko Salomaa, Erkki Vartiainen, Kennet Harald, Tanja Zeller, Daniel Levy, Toshiharu Ninomiya, Jun Hata, Yutaka Kiyohara, Jussi Kauhanen, Jukka T. Salonen, Jari A. Laukkanen, Tomi Pekka Tuomainen, Heikki Ruskoaho, Caroline N. Kistorp, Ilan Raymond, Michael Hecht Olsen, Thomas Mueller, Benjamin Dieplinger, Meinhard Haltmayer, Olle Melander, Mary Cushman, Susan R. Heckbert, Bruce M. Psaty, João A. Lima, Andreas Luchner, Klaus Stark, Iris M. Heid, Annette Peters, Jonas Andersson, Jan Håkan Jansson, Patrik Wennberg, Speranza Rubattu, Massimo Volpe, Pasquale Strazzullo, Lars Lind, Per Venge, Bertil Lindahl, Rudolf A. de Boer, Stephan J.L. Bakker, Ron T. Gansevoort, Frank Kee, Alun Evans, John W.G. Yarnell, Stella Trompet, J. Wouter Jukema, David J. Stott, Anton J.M. de Craen, Jens Rosenberg, Per R. Hildebrandt, Finn Gustafsson, Morten Schou, Lori B. Daniels, Elizabeth Barrett-Connor, Alan S. Maisel, Mary Cushman, Suzanne Judd, Monika M. Safford, Virginia J. Howard, Neil A. Zakai, Vilmundur Gudnason, Thor Aspelund, Gudny Eiriksdottir, Uggi Agnarsson, Margret B. Andresdottir, Maryam Kavousi, Albert Hofman, Symen Ligthart, Anton H. van den Meiracker, Jorge Kizer, Abbas Dehghan, Frank J.A. van Rooij, M. Arfan Ikram, Jorge R. Kizer, Lyle G. Best, Richard B. Devereux, Jason G. Umans, Johan Ärnlöv, Björn Zethelius, Lars Lannfelt, Vilmantas Giedraitis, Nancy R. Cook, Jo Ann E. Manson, Brendan M. Everett, Paul M. Ridker, Brendan M. Everett, Nancy R. Cook, Paul M. Ridker, Aruna D. Pradhan, Naveed Sattar, Ian Ford, Chris J. Packard, Paul Welsh

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)840-849
Number of pages10
JournalThe Lancet Diabetes and Endocrinology
Volume4
Issue number10
DOIs
StatePublished - Oct 1 2016

Fingerprint

Natriuretic Peptides
Coronary Disease
Meta-Analysis
Brain Natriuretic Peptide
Cardiovascular Diseases
Stroke
Heart Failure
Primary Prevention
Odds Ratio
Prospective Studies
Blood Pressure
National Institutes of Health (U.S.)
Research
PubMed
HDL Cholesterol
Biomedical Research
Language
Smoking
Guidelines

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Nambi, V., Ballantyne, C. M., Hoogeveen, R. C., Agarwal, S. K., Panagiotakos, D. B., Wannamethee, S. G., ... Welsh, P. (2016). Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis. The Lancet Diabetes and Endocrinology, 4(10), 840-849. https://doi.org/10.1016/S2213-8587(16)30196-6

Natriuretic peptides and integrated risk assessment for cardiovascular disease : an individual-participant-data meta-analysis. / Nambi, Vijay; Ballantyne, Christie M.; Hoogeveen, Ron C.; Agarwal, Sunil K.; Panagiotakos, Demosthenes B.; Wannamethee, S. Goya; Whincup, Peter H.; Kiechl, Stefan; Willeit, Johann; Schett, Georg; Santer, Peter; Willeit, Peter; Casas, Juan Pablo; Lawlor, Debbie A.; DeFilippi, Christopher; Kronmal, Richard A.; Psaty, Bruce M.; Cushman, Mary; Nordestgaard, Børge G.; Olsen, Michael Hecht; Jørgensen, Torben; de Lemos, James A.; McGuire, Darren K.; Das, Sandeep R.; Drazner, Mark H.; Salomaa, Veikko; Vartiainen, Erkki; Harald, Kennet; Zeller, Tanja; Levy, Daniel; Ninomiya, Toshiharu; Hata, Jun; Kiyohara, Yutaka; Kauhanen, Jussi; Salonen, Jukka T.; Laukkanen, Jari A.; Tuomainen, Tomi Pekka; Ruskoaho, Heikki; Kistorp, Caroline N.; Raymond, Ilan; Olsen, Michael Hecht; Mueller, Thomas; Dieplinger, Benjamin; Haltmayer, Meinhard; Melander, Olle; Cushman, Mary; Heckbert, Susan R.; Psaty, Bruce M.; Lima, João A.; Luchner, Andreas; Stark, Klaus; Heid, Iris M.; Peters, Annette; Andersson, Jonas; Jansson, Jan Håkan; Wennberg, Patrik; Rubattu, Speranza; Volpe, Massimo; Strazzullo, Pasquale; Lind, Lars; Venge, Per; Lindahl, Bertil; de Boer, Rudolf A.; Bakker, Stephan J.L.; Gansevoort, Ron T.; Kee, Frank; Evans, Alun; Yarnell, John W.G.; Trompet, Stella; Jukema, J. Wouter; Stott, David J.; de Craen, Anton J.M.; Rosenberg, Jens; Hildebrandt, Per R.; Gustafsson, Finn; Schou, Morten; Daniels, Lori B.; Barrett-Connor, Elizabeth; Maisel, Alan S.; Cushman, Mary; Judd, Suzanne; Safford, Monika M.; Howard, Virginia J.; Zakai, Neil A.; Gudnason, Vilmundur; Aspelund, Thor; Eiriksdottir, Gudny; Agnarsson, Uggi; Andresdottir, Margret B.; Kavousi, Maryam; Hofman, Albert; Ligthart, Symen; van den Meiracker, Anton H.; Kizer, Jorge; Dehghan, Abbas; van Rooij, Frank J.A.; Ikram, M. Arfan; Kizer, Jorge R.; Best, Lyle G.; Devereux, Richard B.; Umans, Jason G.; Ärnlöv, Johan; Zethelius, Björn; Lannfelt, Lars; Giedraitis, Vilmantas; Cook, Nancy R.; Manson, Jo Ann E.; Everett, Brendan M.; Ridker, Paul M.; Everett, Brendan M.; Cook, Nancy R.; Ridker, Paul M.; Pradhan, Aruna D.; Sattar, Naveed; Ford, Ian; Packard, Chris J.; Welsh, Paul.

In: The Lancet Diabetes and Endocrinology, Vol. 4, No. 10, 01.10.2016, p. 840-849.

Research output: Contribution to journalArticle

Nambi, V, Ballantyne, CM, Hoogeveen, RC, Agarwal, SK, Panagiotakos, DB, Wannamethee, SG, Whincup, PH, Kiechl, S, Willeit, J, Schett, G, Santer, P, Willeit, P, Casas, JP, Lawlor, DA, DeFilippi, C, Kronmal, RA, Psaty, BM, Cushman, M, Nordestgaard, BG, Olsen, MH, Jørgensen, T, de Lemos, JA, McGuire, DK, Das, SR, Drazner, MH, Salomaa, V, Vartiainen, E, Harald, K, Zeller, T, Levy, D, Ninomiya, T, Hata, J, Kiyohara, Y, Kauhanen, J, Salonen, JT, Laukkanen, JA, Tuomainen, TP, Ruskoaho, H, Kistorp, CN, Raymond, I, Olsen, MH, Mueller, T, Dieplinger, B, Haltmayer, M, Melander, O, Cushman, M, Heckbert, SR, Psaty, BM, Lima, JA, Luchner, A, Stark, K, Heid, IM, Peters, A, Andersson, J, Jansson, JH, Wennberg, P, Rubattu, S, Volpe, M, Strazzullo, P, Lind, L, Venge, P, Lindahl, B, de Boer, RA, Bakker, SJL, Gansevoort, RT, Kee, F, Evans, A, Yarnell, JWG, Trompet, S, Jukema, JW, Stott, DJ, de Craen, AJM, Rosenberg, J, Hildebrandt, PR, Gustafsson, F, Schou, M, Daniels, LB, Barrett-Connor, E, Maisel, AS, Cushman, M, Judd, S, Safford, MM, Howard, VJ, Zakai, NA, Gudnason, V, Aspelund, T, Eiriksdottir, G, Agnarsson, U, Andresdottir, MB, Kavousi, M, Hofman, A, Ligthart, S, van den Meiracker, AH, Kizer, J, Dehghan, A, van Rooij, FJA, Ikram, MA, Kizer, JR, Best, LG, Devereux, RB, Umans, JG, Ärnlöv, J, Zethelius, B, Lannfelt, L, Giedraitis, V, Cook, NR, Manson, JAE, Everett, BM, Ridker, PM, Everett, BM, Cook, NR, Ridker, PM, Pradhan, AD, Sattar, N, Ford, I, Packard, CJ & Welsh, P 2016, 'Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis', The Lancet Diabetes and Endocrinology, vol. 4, no. 10, pp. 840-849. https://doi.org/10.1016/S2213-8587(16)30196-6
Nambi, Vijay ; Ballantyne, Christie M. ; Hoogeveen, Ron C. ; Agarwal, Sunil K. ; Panagiotakos, Demosthenes B. ; Wannamethee, S. Goya ; Whincup, Peter H. ; Kiechl, Stefan ; Willeit, Johann ; Schett, Georg ; Santer, Peter ; Willeit, Peter ; Casas, Juan Pablo ; Lawlor, Debbie A. ; DeFilippi, Christopher ; Kronmal, Richard A. ; Psaty, Bruce M. ; Cushman, Mary ; Nordestgaard, Børge G. ; Olsen, Michael Hecht ; Jørgensen, Torben ; de Lemos, James A. ; McGuire, Darren K. ; Das, Sandeep R. ; Drazner, Mark H. ; Salomaa, Veikko ; Vartiainen, Erkki ; Harald, Kennet ; Zeller, Tanja ; Levy, Daniel ; Ninomiya, Toshiharu ; Hata, Jun ; Kiyohara, Yutaka ; Kauhanen, Jussi ; Salonen, Jukka T. ; Laukkanen, Jari A. ; Tuomainen, Tomi Pekka ; Ruskoaho, Heikki ; Kistorp, Caroline N. ; Raymond, Ilan ; Olsen, Michael Hecht ; Mueller, Thomas ; Dieplinger, Benjamin ; Haltmayer, Meinhard ; Melander, Olle ; Cushman, Mary ; Heckbert, Susan R. ; Psaty, Bruce M. ; Lima, João A. ; Luchner, Andreas ; Stark, Klaus ; Heid, Iris M. ; Peters, Annette ; Andersson, Jonas ; Jansson, Jan Håkan ; Wennberg, Patrik ; Rubattu, Speranza ; Volpe, Massimo ; Strazzullo, Pasquale ; Lind, Lars ; Venge, Per ; Lindahl, Bertil ; de Boer, Rudolf A. ; Bakker, Stephan J.L. ; Gansevoort, Ron T. ; Kee, Frank ; Evans, Alun ; Yarnell, John W.G. ; Trompet, Stella ; Jukema, J. Wouter ; Stott, David J. ; de Craen, Anton J.M. ; Rosenberg, Jens ; Hildebrandt, Per R. ; Gustafsson, Finn ; Schou, Morten ; Daniels, Lori B. ; Barrett-Connor, Elizabeth ; Maisel, Alan S. ; Cushman, Mary ; Judd, Suzanne ; Safford, Monika M. ; Howard, Virginia J. ; Zakai, Neil A. ; Gudnason, Vilmundur ; Aspelund, Thor ; Eiriksdottir, Gudny ; Agnarsson, Uggi ; Andresdottir, Margret B. ; Kavousi, Maryam ; Hofman, Albert ; Ligthart, Symen ; van den Meiracker, Anton H. ; Kizer, Jorge ; Dehghan, Abbas ; van Rooij, Frank J.A. ; Ikram, M. Arfan ; Kizer, Jorge R. ; Best, Lyle G. ; Devereux, Richard B. ; Umans, Jason G. ; Ärnlöv, Johan ; Zethelius, Björn ; Lannfelt, Lars ; Giedraitis, Vilmantas ; Cook, Nancy R. ; Manson, Jo Ann E. ; Everett, Brendan M. ; Ridker, Paul M. ; Everett, Brendan M. ; Cook, Nancy R. ; Ridker, Paul M. ; Pradhan, Aruna D. ; Sattar, Naveed ; Ford, Ian ; Packard, Chris J. ; Welsh, Paul. / Natriuretic peptides and integrated risk assessment for cardiovascular disease : an individual-participant-data meta-analysis. In: The Lancet Diabetes and Endocrinology. 2016 ; Vol. 4, No. 10. pp. 840-849.
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title = "Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis",
abstract = "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.",
author = "Vijay Nambi and Ballantyne, {Christie M.} and Hoogeveen, {Ron C.} and Agarwal, {Sunil K.} and Panagiotakos, {Demosthenes B.} and Wannamethee, {S. Goya} and Whincup, {Peter H.} and Stefan Kiechl and Johann Willeit and Georg Schett and Peter Santer and Peter Willeit and Casas, {Juan Pablo} and Lawlor, {Debbie A.} and Christopher DeFilippi and Kronmal, {Richard A.} and Psaty, {Bruce M.} and Mary Cushman and Nordestgaard, {B{\o}rge G.} and Olsen, {Michael Hecht} and Torben J{\o}rgensen and {de Lemos}, {James A.} and McGuire, {Darren K.} and Das, {Sandeep R.} and Drazner, {Mark H.} and Veikko Salomaa and Erkki Vartiainen and Kennet Harald and Tanja Zeller and Daniel Levy and Toshiharu Ninomiya and Jun Hata and Yutaka Kiyohara and Jussi Kauhanen and Salonen, {Jukka T.} and Laukkanen, {Jari A.} and Tuomainen, {Tomi Pekka} and Heikki Ruskoaho and Kistorp, {Caroline N.} and Ilan Raymond and Olsen, {Michael Hecht} and Thomas Mueller and Benjamin Dieplinger and Meinhard Haltmayer and Olle Melander and Mary Cushman and Heckbert, {Susan R.} and Psaty, {Bruce M.} and Lima, {Jo{\~a}o A.} and Andreas Luchner and Klaus Stark and Heid, {Iris M.} and Annette Peters and Jonas Andersson and Jansson, {Jan H{\aa}kan} and Patrik Wennberg and Speranza Rubattu and Massimo Volpe and Pasquale Strazzullo and Lars Lind and Per Venge and Bertil Lindahl and {de Boer}, {Rudolf A.} and Bakker, {Stephan J.L.} and Gansevoort, {Ron T.} and Frank Kee and Alun Evans and Yarnell, {John W.G.} and Stella Trompet and Jukema, {J. Wouter} and Stott, {David J.} and {de Craen}, {Anton J.M.} and Jens Rosenberg and Hildebrandt, {Per R.} and Finn Gustafsson and Morten Schou and Daniels, {Lori B.} and Elizabeth Barrett-Connor and Maisel, {Alan S.} and Mary Cushman and Suzanne Judd and Safford, {Monika M.} and Howard, {Virginia J.} and Zakai, {Neil A.} and Vilmundur Gudnason and Thor Aspelund and Gudny Eiriksdottir and Uggi Agnarsson and Andresdottir, {Margret B.} and Maryam Kavousi and Albert Hofman and Symen Ligthart and {van den Meiracker}, {Anton H.} and Jorge Kizer and Abbas Dehghan and {van Rooij}, {Frank J.A.} and Ikram, {M. Arfan} and Kizer, {Jorge R.} and Best, {Lyle G.} and Devereux, {Richard B.} and Umans, {Jason G.} and Johan {\"A}rnl{\"o}v and Bj{\"o}rn Zethelius and Lars Lannfelt and Vilmantas Giedraitis and Cook, {Nancy R.} and Manson, {Jo Ann E.} and Everett, {Brendan M.} and Ridker, {Paul M.} and Everett, {Brendan M.} and Cook, {Nancy R.} and Ridker, {Paul M.} and Pradhan, {Aruna D.} and Naveed Sattar and Ian Ford and Packard, {Chris J.} and Paul Welsh",
year = "2016",
month = "10",
day = "1",
doi = "10.1016/S2213-8587(16)30196-6",
language = "English (US)",
volume = "4",
pages = "840--849",
journal = "The Lancet Diabetes and Endocrinology",
issn = "2213-8587",
publisher = "Elsevier BV",
number = "10",

}

TY - JOUR

T1 - Natriuretic peptides and integrated risk assessment for cardiovascular disease

T2 - an individual-participant-data meta-analysis

AU - Nambi, Vijay

AU - Ballantyne, Christie M.

AU - Hoogeveen, Ron C.

AU - Agarwal, Sunil K.

AU - Panagiotakos, Demosthenes B.

AU - Wannamethee, S. Goya

AU - Whincup, Peter H.

AU - Kiechl, Stefan

AU - Willeit, Johann

AU - Schett, Georg

AU - Santer, Peter

AU - Willeit, Peter

AU - Casas, Juan Pablo

AU - Lawlor, Debbie A.

AU - DeFilippi, Christopher

AU - Kronmal, Richard A.

AU - Psaty, Bruce M.

AU - Cushman, Mary

AU - Nordestgaard, Børge G.

AU - Olsen, Michael Hecht

AU - Jørgensen, Torben

AU - de Lemos, James A.

AU - McGuire, Darren K.

AU - Das, Sandeep R.

AU - Drazner, Mark H.

AU - Salomaa, Veikko

AU - Vartiainen, Erkki

AU - Harald, Kennet

AU - Zeller, Tanja

AU - Levy, Daniel

AU - Ninomiya, Toshiharu

AU - Hata, Jun

AU - Kiyohara, Yutaka

AU - Kauhanen, Jussi

AU - Salonen, Jukka T.

AU - Laukkanen, Jari A.

AU - Tuomainen, Tomi Pekka

AU - Ruskoaho, Heikki

AU - Kistorp, Caroline N.

AU - Raymond, Ilan

AU - Olsen, Michael Hecht

AU - Mueller, Thomas

AU - Dieplinger, Benjamin

AU - Haltmayer, Meinhard

AU - Melander, Olle

AU - Cushman, Mary

AU - Heckbert, Susan R.

AU - Psaty, Bruce M.

AU - Lima, João A.

AU - Luchner, Andreas

AU - Stark, Klaus

AU - Heid, Iris M.

AU - Peters, Annette

AU - Andersson, Jonas

AU - Jansson, Jan Håkan

AU - Wennberg, Patrik

AU - Rubattu, Speranza

AU - Volpe, Massimo

AU - Strazzullo, Pasquale

AU - Lind, Lars

AU - Venge, Per

AU - Lindahl, Bertil

AU - de Boer, Rudolf A.

AU - Bakker, Stephan J.L.

AU - Gansevoort, Ron T.

AU - Kee, Frank

AU - Evans, Alun

AU - Yarnell, John W.G.

AU - Trompet, Stella

AU - Jukema, J. Wouter

AU - Stott, David J.

AU - de Craen, Anton J.M.

AU - Rosenberg, Jens

AU - Hildebrandt, Per R.

AU - Gustafsson, Finn

AU - Schou, Morten

AU - Daniels, Lori B.

AU - Barrett-Connor, Elizabeth

AU - Maisel, Alan S.

AU - Cushman, Mary

AU - Judd, Suzanne

AU - Safford, Monika M.

AU - Howard, Virginia J.

AU - Zakai, Neil A.

AU - Gudnason, Vilmundur

AU - Aspelund, Thor

AU - Eiriksdottir, Gudny

AU - Agnarsson, Uggi

AU - Andresdottir, Margret B.

AU - Kavousi, Maryam

AU - Hofman, Albert

AU - Ligthart, Symen

AU - van den Meiracker, Anton H.

AU - Kizer, Jorge

AU - Dehghan, Abbas

AU - van Rooij, Frank J.A.

AU - Ikram, M. Arfan

AU - Kizer, Jorge R.

AU - Best, Lyle G.

AU - Devereux, Richard B.

AU - Umans, Jason G.

AU - Ärnlöv, Johan

AU - Zethelius, Björn

AU - Lannfelt, Lars

AU - Giedraitis, Vilmantas

AU - Cook, Nancy R.

AU - Manson, Jo Ann E.

AU - Everett, Brendan M.

AU - Ridker, Paul M.

AU - Everett, Brendan M.

AU - Cook, Nancy R.

AU - Ridker, Paul M.

AU - Pradhan, Aruna D.

AU - Sattar, Naveed

AU - Ford, Ian

AU - Packard, Chris J.

AU - Welsh, Paul

PY - 2016/10/1

Y1 - 2016/10/1

N2 - 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.

AB - 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.

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U2 - 10.1016/S2213-8587(16)30196-6

DO - 10.1016/S2213-8587(16)30196-6

M3 - Article

C2 - 27599814

AN - SCOPUS:84990052413

VL - 4

SP - 840

EP - 849

JO - The Lancet Diabetes and Endocrinology

JF - The Lancet Diabetes and Endocrinology

SN - 2213-8587

IS - 10

ER -