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?
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.
Olsen
Michael H
MH
Research Center for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark. mho@dadlnet.dk
Sehestedt
Thomas
T
Lyngbaek
Stig
S
Hansen
Tine W
TW
Rasmussen
Susanne
S
Wachtell
Kristian
K
Torp-Pedersen
Christian
C
Hildebrandt
Per R
PR
Ibsen
Hans
H
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
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