title: N-terminal pro brain natriuretic peptide but not copeptin improves prediction of heart failure over other routine clinical risk parameters in older men with and without cardiovascular disease: population-based study.
abstract: OBJECTIVE
  Measurement of NT-proBNP and copeptin may help identify those at high risk of heart failure (HF). However the value of NT-proBNP and copeptin has been little studied in the older population in primary care. This study aims to examine the use of NT-proBNP and copeptin in improving risk prediction and stratification of HF in older men with and without cardiovascular disease (CVD).
  
  
  RESULTS
  This was a prospective study of 3870 men aged 60-79 years with no diagnosed HF followed up for a mean period of 11 years, during which there were 254 incident HF cases. NT-proBNP was associated with HF in those with and without established CVD [diagnosed myocardial infarction (MI), angina, or stroke]. NT-proBNP improved prediction beyond routine conventional risk factors (age, obesity, diabetes, hypertension, history of MI, and history of angina) and the Health ABC Heart Failure Score in all men and in men with and without established CVD (P<0.0001 for improvement in c-statistics). The net reclassification index (NRI) beyond conventional risk factors was 18.8% overall (27.4% for men without CVD and 17.4% for men with CVD). In contrast, copeptin was associated with HF in men with CVD only and did not improve prediction of HF after inclusion of conventional risk factors (P = 0.95 for improvement in c-statistics).
  
  
  CONCLUSIONS
  NT-proBNP, but not copeptin significantly improves prediction and risk stratification of HF beyond routine clinical parameters obtained in general practice settings in older men both with and without established CVD.
authors.affiliation: Department of Primary Care and Population Health, UCL, London, UK.
authors.forename: S Goya
authors.initials: SG
authors.lastname: Wannamethee
authors.forename: Paul
authors.initials: P
authors.lastname: Welsh
authors.forename: Peter H
authors.initials: PH
authors.lastname: Whincup
authors.forename: Lucy
authors.initials: L
authors.lastname: Lennon
authors.forename: Olia
authors.initials: O
authors.lastname: Papacosta
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases; D018450:Disease Progression; D005500:Follow-Up Studies; D006020:Glycopeptides / Q000097:blood*; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D010446:Peptide Fragments; D011498:Protein Precursors; C048197:copeptins; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Copeptin; Epidemiology; Heart failure; NT‐proBNP