title: Prognostic value of NT-pro-BNP and hs-CRP for risk stratification in primary care: results from the population-based DETECT study.
abstract: BACKGROUND
  There is continuous debate to the use of biomarkers in the general practitioners office and to what degree the established biomarkers N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and high-sensitive C-reactive protein (hs-CRP) might contribute to improved prediction of incident cardiovascular events.
  
  
  OBJECTIVE
  To evaluate the utility and 5-year predictive value of a single measurement of NT-pro-BNP and hs-CRP for incident cardiovascular events, and its added value beyond the contribution of conventional risk factors in primary care.
  
  
  METHODS
  Five year prospective longitudinal clinical epidemiological study in a nationwide sample of 4,775 primary care subjects (mean age 55.8 years, 62 % women) without coronary artery disease at baseline. Main outcome measures were incident major cardiovascular events and all-cause death.
  
  
  RESULTS
  During the 5 years of follow-up, 188 subjects (3.9 %) died or experienced a first major cardiovascular event. The addition of NT-pro-BNP, but not of hs-CRP to a prediction model with established cardiovascular risk factors improved the prediction of major cardiovascular events (increase in C statistic by 0.009; p = 0.008), and was associated with a significant improvement in net reclassification improvement (NRI = 23.6 %; p = 0.003).
  
  
  CONCLUSIONS
  In a primary care setting, one single measurement of NT-pro-BNP, but not of hs-CRP significantly improves the prediction of incident cardiovascular events.
authors.affiliation: Department of Medicine III Cardiology, Goethe-University Frankfurt, Theodor Stern-Kai. 7, 60590 Frankfurt/Main, Germany. David.Leistner@kgu.de
authors.forename: David M
authors.initials: DM
authors.lastname: Leistner
authors.forename: Jens
authors.initials: J
authors.lastname: Klotsche
authors.forename: Lars
authors.initials: L
authors.lastname: Pieper
authors.forename: Sylvia
authors.initials: S
authors.lastname: Palm
authors.forename: Günter K
authors.initials: GK
authors.lastname: Stalla
authors.forename: Hendrik
authors.initials: H
authors.lastname: Lehnert
authors.forename: Sigmund
authors.initials: S
authors.lastname: Silber
authors.forename: Winfried
authors.initials: W
authors.lastname: März
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Wittchen
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Zeiher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D017063:Outcome Assessment, Health Care; D010446:Peptide Fragments / Q000378:metabolism*; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein