title: Predicting risk of coronary events and all-cause mortality: role of B-type natriuretic peptide above traditional risk factors and coronary artery calcium scoring in the general population: the Heinz Nixdorf Recall Study.
abstract: OBJECTIVE
  Several biomarkers including B-type natriuretic peptide (BNP) have been suggested to improve prediction of coronary events and all-cause mortality. Moreover, coronary artery calcium (CAC) as marker of subclinical atherosclerosis is a strong predictor for cardiovascular mortality and morbidity. We aimed to evaluate the predictive ability of BNP and CAC for all-cause mortality and coronary events above traditional cardiovascular risk factors (TRF) in the general population.
  
  
  METHODS
  We followed 3782 participants of the population-based Heinz Nixdorf Recall cohort study without coronary artery disease at baseline for 7.3 ± 1.3 years. Associations of BNP and CAC with incident coronary events and all-cause mortality were assessed using Cox regression, Harrell's c, and time-dependent integrated discrimination improvement (IDI(t), increase in explained variance).
  
  
  RESULTS
  Subjects with high BNP levels had increased frequency of coronary events and death (coronary events/mortality: 14.1/28.2% for BNP ≥100 pg/ml vs. 2.7/5.5% for BNP < 100 pg/ml, respectively). Subjects with a BNP ≥100 pg/ml had increased incidence of hard endpoints sustaining adjustment for CAC and TRF (for coronary events: hazard ratio (HR) (95% confidence interval (CI)) 3.41(1.78-6.53); for all-cause mortality: HR 3.35(2.15-5.23)). Adding BNP to TRF and CAC increased measures of predictive ability: coronary events (Harrell's c, for coronary events, 0.775-0.784, p = 0.09; for all-cause mortality 0.733-0.740, p = 0.04; and IDI(t) (95% CI), for coronary events: 2.79% (0.33-5.65%) and for all-cause mortality 1.78% (0.73-3.10%).
  
  
  CONCLUSIONS
  Elevated levels of BNP are associated with excess incident coronary events and all-cause mortality rates, with BNP and CAC significantly and complementary improving prediction of risk in the general population above TRF.
authors.affiliation: West-German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany K.kara@klinikum-bochum.de.
authors.forename: Kaffer
authors.initials: K
authors.lastname: Kara
authors.affiliation: West-German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Amir A
authors.initials: AA
authors.lastname: Mahabadi
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Marie H
authors.initials: MH
authors.lastname: Berg
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Lehmann
authors.affiliation: West-German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Möhlenkamp
authors.affiliation: West-German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Kälsch
authors.affiliation: West-German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Bauer
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Nico
authors.initials: N
authors.lastname: Dragano
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Jöckel
authors.affiliation: West-German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Neumann
authors.affiliation: West-German Heart Center, Department of Cardiology, University of Duisburg-Essen, Essen, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002114:Calcinosis / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002423:Cause of Death / Q000639:trends; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011159:Population Surveillance / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: Coronary artery calcium; Heinz Nixdorf Recall Study; natriuretic peptides; prevention; risk factors