N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults
N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults
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DOI：
10.1001/jama.293.13.1609
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发表时间：
2005-04-06
影响因子：
120.7
通讯作者：
Hildebrandt, P
中科院分区：
文献类型：
--
作者：
Kistorp, C;Raymond, I;Hildebrandt, P
背景B型利钠肽已被证明可以预测表面健康个体的心血管疾病，但与C反应蛋白（CRP）和尿白蛋白/肌酐比值相比，其预测死亡率和未来心血管事件的能力尚不清楚。（NT-proBNP）vs CRP和尿白蛋白/肌酐比率在老年人中的研究设计、设置和参与者一项基于人群的前瞻性研究，来自丹麦哥本哈根社区的764名年龄在50至89岁的参与者，其中658名参与者提供了血液和尿液样本，并在1998年9月1日至2000年1月24日期间进行了检查。在这些参与者中，626名没有心脏或肾衰竭的参与者被招募。537例亚组在基线时无心血管疾病史。5年随访期间主要结果通过基线水平的NT-proBNP、CRP和尿白蛋白/肌酐比值水平来测量死亡率和首次主要心血管事件的风险。结果在校正年龄、性别、吸烟、糖尿病等心血管危险因素后，高血压或缺血性心脏病、总胆固醇和血清肌酐，NT-proBNP值高于第80百分位数的死亡率风险比（HR）为1.96（95%置信区间[CI]，1.21-3.19）; CRP，1.46（95% CI，0.89-2.24）;尿白蛋白/肌酐比值，1.88（95% CI，1.18-2.98）。对左心室收缩功能不全进行额外调整并未显著降低NT-proBNP的预测值（HR，1.82; 95% CI，1.11-2.98）。对于数值高于第80百分位数与等于或低于第80百分位数的受试者，NT-proBNP、CRP和尿白蛋白/肌酐比值的死亡风险绝对未校正增加分别为24.5%、7.8%和19.5%。NT-proBNP水平与首次主要心血管事件相关（非致死性心肌梗死、致死性冠心病、不稳定型心绞痛、心力衰竭、卒中和短暂性脑缺血发作），校正HR为3.24（95% CI，1.80-5.79）vs 1.02（95% CI，0.56-1.85），CRP和2.32（95%可信区间，1.33-4.05）的尿白蛋白/肌酐比值时，比较参与者的值高于第80百分位数与那些值等于或低于第80百分位数。proBNP提供了死亡率和首次主要心血管事件的预后信息，超出了传统的危险因素。在年龄50 - 89岁的非住院患者中，NT-proBNP是心血管疾病和死亡的风险生物标志物，比CRP更强。
Context B-type natriuretic peptides have been shown to predict cardiovascular disease in apparently healthy individuals but their predictive ability for mortality and future cardiovascular events compared with C-reactive protein (CRP) and urinary albumin/creatinine ratio is unknown.Objective To assess the prognostic value of the N-amino terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) vs CRP and urinary albumin/creatinine ratio in an older adult population.Design, Setting, and Participants A population-based prospective study of 764 participants aged 50 to 89 years from a community in Copenhagen, Denmark, in which 658 participants provided blood and urinary samples and were examined between September 1, 1998, and January 24, 2000. Of these participants, 626 without heart or renal failure were enrolled. A subgroup of 537 had no history of cardiovascular disease at baseline. During 5 years of follow-up (to December 31, 2003), 94 participants died and 65 developed a first major cardiovascular event.Main Outcome Measures Risk of mortality and first major cardiovascular event by baseline levels of NT-proBNP, CRP, and urinary albumin/creatinine ratio levels.Results After adjustment for the cardiovascular risk factors of age, sex, smoking, diabetes mellitus, hypertension or ischemic heart disease, total cholesterol, and serum creatinine, the hazard ratio (HR) of mortality for values above the 80th percentile of NT-proBNP was 1.96 (95% confidence interval [CI], 1.21-3.19); for CRP, 1.46 (95% CI, 0.89-2.24); and for urinary albumin/creatinine ratio, 1.88 (95% CI, 1.18-2.98). Additional adjustment for left ventricular systolic dysfunction did not markedly attenuate the predictive value of NT-proBNP (HR, 1.82; 95% CI, 1.11-2.98). The absolute unadjusted increase in mortality risk for participants with values above the 80th percentile vs equal to or below the 80th percentile was 24.5% for NT-proBNP, 7.8% for CRP, and 19.5% for urinary albumin/creatinine ratio. The NT-proBNP levels were associated with first major cardiovascular events (nonfatal myocardial infarction, fatal coronary heart disease, unstable angina, heart failure, stroke, and transient ischemic attack) with an adjusted HR of 3.24 (95% CI, 1.80-5.79) vs 1.02 (95% CI, 0.56-1.85) for CRP and 2.32 (95% CI, 1.33-4.05) for urinary albumin/creatinine ratio when comparing participants with values above the 80th percentile with those with values equal to or below the 80th percentile.Conclusions Measurements of NT-proBNP provide prognostic information of mortality and first major cardiovascular events beyond traditional risk factors. NT-proBNP was a stronger risk biomarker for cardiovascular disease and death than CRP was in nonhospitalized individuals aged 50 to 89 years.