Dataset Information

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.

SUBMITTER: Natriuretic Peptides Studies Collaboration

PROVIDER: S-EPMC5035346 | biostudies-literature | 2016 Oct

REPOSITORIES: biostudies-literature

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Publications

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

Natriuretic Peptides Studies Collaboration Willeit Peter P Kaptoge Stephen S Welsh Paul P Butterworth Adam AS Chowdhury Rajiv R Spackman Sarah SA Pennells Lisa L Gao Pei P Burgess Stephen S Freitag Daniel DF Sweeting Michael M Wood Angela AM Cook Nancy NR Judd Suzanne S Trompet Stella S Nambi Vijay V Olsen Michael MH Everett Brendan BM Kee Frank F Ärnlöv Johan J Salomaa Veikko V Levy Daniel D Kauhanen Jussi J Laukkanen Jari JA Kavousi Maryam M Ninomiya Toshiharu T Casas Juan-Pablo JP Daniels Lori LB Lind Lars L Kistorp Caroline CN Rosenberg Jens J Mueller Thomas T Rubattu Speranza S Panagiotakos Demosthenes DB Franco Oscar OH de Lemos James JA Luchner Andreas A Kizer Jorge JR Kiechl Stefan S Salonen Jukka JT Goya Wannamethee S S de Boer Rudolf RA Nordestgaard Børge BG Andersson Jonas J Jørgensen Torben T Melander Olle O Ballantyne Christie ChM DeFilippi Christopher Ch Ridker Paul PM Cushman Mary M Rosamond Wayne WD Thompson Simon SG Gudnason Vilmundur V Sattar Naveed N Danesh John J Di Angelantonio Emanuele E

The lancet. Diabetes & endocrinology 20160903 10

<h4>Background</h4>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.<h4>Methods</h4>In this individual-participant-data meta-analysis, we generated and harmonised individua ...[more]

PMID: 27599814

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Dataset Information

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

Background

Methods

Findings

Interpretation

Funding

Publications

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

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