N-Terminal Pro-Brain Natriuretic Peptide Is a More Useful Predictor of Cardiovascular Disease Risk Than C-Reactive Protein in Older Men With and Without Pre-Existing Cardiovascular Disease
N-Terminal Pro-Brain Natriuretic Peptide Is a More Useful Predictor of Cardiovascular Disease Risk Than C-Reactive Protein in Older Men With and Without Pre-Existing Cardiovascular Disease
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DOI：
10.1016/j.jacc.2011.02.041
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发表时间：
2011-06-28
影响因子：
24
通讯作者：
Sattar, Naveed
中科院分区：
文献类型：
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作者：
Wannamethee, S. Goya;Welsh, Paul;Sattar, Naveed
目的：比较n端脑利钠肽前体（NT-proBNP）和c反应蛋白（CRP）对老年男性心血管疾病（CVD）风险的预测能力。背景NT-proBNP在普通人群心血管疾病风险分层中的临床应用尚不清楚。方法对3649名年龄在60 - 79岁之间的男性进行了平均9年的前瞻性研究，其中608例主要心血管事件（主要致死性和非致死性冠心病、中风和心血管疾病死亡）。结果：调整心血管危险因素后，NT-proBNP与所有主要心血管疾病结局的风险显著相关，无论是否患有心血管疾病。未存在CVD者和存在CVD者的CVD事件校正标准化风险比分别为1.49（95%可信区间[CI]: 1.33 ~ 1.65）和1.52 （95% CI: 1.33 ~ 1.75）。CRP与CVD结果的相关性仅存在于无CVD的男性中（校正标准化风险比分别为1.22 [95% CI: 1.10至1.34]和1.00 [95% CI: 0.86至1.38]）。NT-proBNP与CVD预后的相关性比CRP更强，特别是在已有CVD的患者中。在framingham模型中纳入NT-proBNP，在有和没有心血管疾病的男性中，c统计数据均有显著改善，对于主要心血管疾病事件，净重分类改善分别为8.8% （p = 0.0009）和8.2% （p < 0.05）。在framingham模型中纳入CRP并没有改善两组患者的预测（净重分类改善分别为3.8%和0.6%）。结论NT-proBNP，而非CRP，改善了有或无CVD的老年男性主要CVD事件的预测。[J]中华医学会心脏科杂志2011；58:56-64)(C) 2011
Objectives We aimed to compare the predictive capabilities of N-terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) for risk of cardiovascular disease (CVD) in older men with and without pre-existing CVD.Background The clinical utility of NT-proBNP in CVD risk stratification in the general population remains unclear.Methods A prospective study of 3,649 men age 60 to 79 years were followed for a mean of 9 years during which there were 608 major CVD events (major fatal and nonfatal coronary heart disease, stroke, and CVD death).Results NT-proBNP was significantly associated with risk of all major CVD outcomes after adjustment for CV risk factors in both men with and without CVD. The adjusted standardized hazard ratios for CVD events in those without preexisting CVD and those with pre-existing CVD were 1.49 (95% confidence interval [CI]: 1.33 to 1.65) and 1.52 (95% CI: 1.33 to 1.75), respectively. CRP was associated with CVD outcomes only in men without pre-existing CVD (adjusted standardized hazard ratios: 1.22 [95% CI: 1.10 to 1.34] and 1.00 [95% CI: 0.86 to 1.38], respectively). NT-proBNP was more strongly associated with CVD outcome than CRP, particularly among those with preexisting CVD. Inclusion of NT-proBNP in a Framingham-based model yielded significant improvement in C-statistics in both men with and without CVD and resulted in a net reclassification improvement of 8.8% (p = 0.0009) and 8.2% (p < 0.05), respectively, for major CVD events. Inclusion of CRP in the Framingham-based model did not improve prediction in either group (net reclassification improvement 3.8% and 0.6%, respectively).Conclusions NT-proBNP, but not CRP, improved prediction of major CVD events in older men with and without pre-existing CVD. (J Am Coll Cardiol 2011;58:56-64) (C) 2011 by the American College of Cardiology Foundation