title: NT-proBNP is associated with coronary heart disease risk in healthy older women but fails to enhance prediction beyond established risk factors: results from the British Women's Heart and Health Study.
abstract: OBJECTIVE
  Limited evidence suggests NT-proBNP improves prediction of coronary heart disease (CHD) events but further data are needed, especially in people without pre-existing CHD and in women.
  
  
  METHODS
  We measured NT-proBNP in serum from 162 women with incident CHD events and 1226 controls (60-79 years) in a case-control study nested within the prospective British Women's Heart and Health Study. All cases and controls were free from CHD at baseline. We related NT-proBNP to CHD event risk, and determined to what extent NT-proBNP enhanced CHD risk prediction beyond established risk factors.
  
  
  RESULTS
  The odds ratio for CHD per 1 standard deviation increase in log(e)NT-proBNP was 1.37 (95% CI: 1.13-1.68) in analyses adjusted for established CHD risk factors, social class, CRP and insulin. However, addition of log(e)NT-proBNP did not improve the discrimination of a prediction model including age, social class, smoking, physical activity, lipids, fasting glucose, waist:hip ratio, hypertension, statin and aspirin use, nor a standard Framingham risk score model; area under the receiver operator curve for the former model increased from 0.676 to 0.687 on inclusion of NT-proBNP (p=0.3). Furthermore, adding NT-proBNP did not improve calibration of a prediction model containing established risk factors, nor did inclusion more appropriately re-classify participants in relation to their final outcome. Findings were similar (independent associations, but no prediction improvement) for fasting insulin and CRP.
  
  
  CONCLUSIONS
  These results caution against use of NT-proBNP for CHD risk prediction in healthy women and suggest a need for larger studies in both genders to resolve outstanding uncertainties.
authors.affiliation: Division of Cardiovascular and Medical Sciences, BHF Cardiovascular Research Building, Faculty of Medicine, University of Glasgow, 126 University Place, Scotland, UK. nsattar@clinmed.gla.ac.uk
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.forename: Paul
authors.initials: P
authors.lastname: Welsh
authors.forename: Nadeem
authors.initials: N
authors.lastname: Sarwar
authors.forename: John
authors.initials: J
authors.lastname: Danesh
authors.forename: Emanuele
authors.initials: E
authors.lastname: Di Angelantonio
authors.forename: Vilmundur
authors.initials: V
authors.lastname: Gudnason
authors.forename: George
authors.initials: G
authors.lastname: Davey Smith
authors.forename: Shah
authors.initials: S
authors.lastname: Ebrahim
authors.forename: Debbie A
authors.initials: DA
authors.lastname: Lawlor
mesh_terms: D015415:Biomarkers / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D004739:England; D005260:Female; D006801:Humans; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain