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

Natriuretic Peptides Studies Collaboration

doi:10.1016/S2213-8587(16)30196-6

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

Natriuretic Peptides Studies Collaboration

Institut for Klinisk Medicin

78 Citationer (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.

Originalsprog	Engelsk
Tidsskrift	The Lancet Diabetes & Endocrinology
Vol/bind	4
Udgave nummer	10
Sider (fra-til)	840-849
Antal sider	10
ISSN	2213-8587
DOI	https://doi.org/10.1016/S2213-8587(16)30196-6
Status	Udgivet - 1 okt. 2016

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10.1016/S2213-8587(16)30196-6Licens: CC BY

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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.",

keywords = "Journal Article",

author = "Peter Willeit and Stephen Kaptoge and Paul Welsh and Butterworth, {Adam S} and Rajiv Chowdhury and Sarah Spackman and Lisa Pennells and Pei Gao and Stephen Burgess and Freitag, {Daniel F} and Michael Sweeting and Angela Wood and Cook, {Nancy R} and Suzanne Judd and Stella Trompet and Vijay Nambi and Olsen, {Michael Hecht} and Everett, {Brendan M.} and Frank Kee and Johan {\"A}rnl{\"o}v and Veikko Salomaa and Daniel Levy and Jussi Kauhanen and Jari Laukkanen and Maryam Kavousi and Toshiharu Ninomiya and Casas, {Juan Pablo} and Lori Daniels and Lars Lind and Caroline Kistorp and Jens Rosenberg and Thomas Mueller and Speranza Rubattu and Panagiotakos, {Demosthenes B} and Oscar Franco and {de Lemos}, James and Andreas Luchner and Kizer, {Jorge R} and Stefan Kiechl and Jukka Salonen and {Goya Wannamethee}, S and {de Boer}, {Rudolf A} and B{\o}rge Nordestgaard and Jonas Andersson and Torben J{\o}rgensen and Olle Melander and Ballantyne, {Christie M} and Christopher DeFilippi and Paul Ridker and Mary Cushman and {Natriuretic Peptides Studies Collaboration}",

year = "2016",

month = oct,

day = "1",

doi = "10.1016/S2213-8587(16)30196-6",

language = "English",

volume = "4",

pages = "840--849",

journal = "The Lancet Diabetes & Endocrinology",

issn = "2213-8587",

publisher = "The Lancet Publishing Group",

number = "10",

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TY - JOUR

T1 - Natriuretic peptides and integrated risk assessment for cardiovascular disease

T2 - an individual-participant-data meta-analysis

AU - Willeit, Peter

AU - Kaptoge, Stephen

AU - Welsh, Paul

AU - Butterworth, Adam S

AU - Chowdhury, Rajiv

AU - Spackman, Sarah

AU - Pennells, Lisa

AU - Gao, Pei

AU - Burgess, Stephen

AU - Freitag, Daniel F

AU - Sweeting, Michael

AU - Wood, Angela

AU - Cook, Nancy R

AU - Judd, Suzanne

AU - Trompet, Stella

AU - Nambi, Vijay

AU - Olsen, Michael Hecht

AU - Everett, Brendan M.

AU - Kee, Frank

AU - Ärnlöv, Johan

AU - Salomaa, Veikko

AU - Levy, Daniel

AU - Kauhanen, Jussi

AU - Laukkanen, Jari

AU - Kavousi, Maryam

AU - Ninomiya, Toshiharu

AU - Casas, Juan Pablo

AU - Daniels, Lori

AU - Lind, Lars

AU - Kistorp, Caroline

AU - Rosenberg, Jens

AU - Mueller, Thomas

AU - Rubattu, Speranza

AU - Panagiotakos, Demosthenes B

AU - Franco, Oscar

AU - de Lemos, James

AU - Luchner, Andreas

AU - Kizer, Jorge R

AU - Kiechl, Stefan

AU - Salonen, Jukka

AU - Goya Wannamethee, S

AU - de Boer, Rudolf A

AU - Nordestgaard, Børge

AU - Andersson, Jonas

AU - Jørgensen, Torben

AU - Melander, Olle

AU - Ballantyne, Christie M

AU - DeFilippi, Christopher

AU - Ridker, Paul

AU - Cushman, Mary

AU - Natriuretic Peptides Studies Collaboration

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.

KW - Journal Article

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

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

M3 - Journal article

C2 - 27599814

SN - 2213-8587

VL - 4

SP - 840

EP - 849

JO - Wine Economics and Policy

JF - Wine Economics and Policy

IS - 10

ER -

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

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