title: Urine albumin/creatinine ratio, high sensitivity C-reactive protein and N-terminal pro brain natriuretic peptide--three new cardiovascular risk markers--do they improve risk prediction and influence treatment?
abstract: In order to prioritize limited health resources in a time of increasing demands optimal cardiovascular risk stratification is essential. We tested the additive prognostic value of 3 relatively new, but established cardiovascular risk markers: N-terminal pro brain natriuretic peptide (Nt-proBNP), related to hemodynamic cardiovascular risk factors, high sensitivity C-reactive protein (hsCRP), related to metabolic cardiovascular risk factors and urine albumin/creatinine ratio (UACR), related to hemodynamic as well as metabolic risk factors. In healthy subjects with a 10-year risk of cardiovascular death lower than 5% based on HeartScore and therefore not eligible for primary prevention, the actual 10-year risk of cardiovascular death exceeded 5% in a small subgroup of subjects with UACR higher than the 95-percentile of approximately 1.6 mg/mmol. Combined use of high UACR or high hsCRP identified a larger subgroup of 16% with high cardiovascular risk in which primary prevention may be advised despite low-moderate cardiovascular risk based on HeartScore. Furthermore, combined use of high UACR or high Nt-proBNP in subjects with known cardiovascular disease or diabetes identified a large subgroup of 48% with extremely high cardiovascular risk who should be referred for specialist care to optimize treatment.
authors.affiliation: Research Center for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark. mho@dadlnet.dk
authors.forename: Michael H
authors.initials: MH
authors.lastname: Olsen
authors.forename: Thomas
authors.initials: T
authors.lastname: Sehestedt
authors.forename: Stig
authors.initials: S
authors.lastname: Lyngbaek
authors.forename: Tine W
authors.initials: TW
authors.lastname: Hansen
authors.forename: Susanne
authors.initials: S
authors.lastname: Rasmussen
authors.forename: Kristian
authors.initials: K
authors.lastname: Wachtell
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Per R
authors.initials: PR
authors.lastname: Hildebrandt
authors.forename: Hans
authors.initials: H
authors.lastname: Ibsen
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging; D000419:Albuminuria / Q000150:complications / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002097:C-Reactive Protein / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology* / Q000652:urine; D003404:Creatinine / Q000652:urine*; D048909:Diabetes Complications / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000652:urine; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006023:Glycoproteins / Q000652:urine*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012709:Serum Albumin; D000075462:Serum Albumin, Human; D012720:Severity of Illness Index; D012737:Sex Factors
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D006023:Glycoproteins; D010446:Peptide Fragments; D012709:Serum Albumin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein; D003404:Creatinine; D000075462:Serum Albumin, Human