title: Predictive value of midregional pro-adrenomedullin compared to natriuretic peptides for incident cardiovascular disease and heart failure in the population-based FINRISK 1997 cohort.
abstract: BACKGROUND
  To examine whether midregional pro-adrenomedullin (MR-proADM) plasma concentrations predict incident cardiovascular outcomes in the general population. Natriuretic peptides (N-terminal pro-brain natriuretic peptide (NT-proBNP), B-type natriuretic peptide (BNP), and midregional pro-atrial natriuretic peptide (MR-proANP)) were analyzed for comparison.
  
  
  METHODS
  MR-proADM plasma concentrations and those of the natriuretic peptides were determined in 8444 individuals of the FINRISK 1997 cohort. Patients were followed for 14 years (median). Cox regression analyses, discrimination, and reclassification analyses adjusting for Framingham risk factors were performed to evaluate the additional benefit from MR-proADM.
  
  
  RESULTS
  MR-proADM concentrations significantly predicted all-cause death (hazard ratio highest quintile versus lowest 1.18, 95% confidence interval 1.08-1.28), stroke (1.20, 1.05-1.38), major adverse cardiac events (MACE) (1.27, 1.17-1.37), and heart failure (1.67, 1.49-1.87). MR-proADM remained associated with MACE, death, and heart failure even after additional adjustment for NT-proBNP and C-reactive protein. Adding MR-proADM to the Framingham risk factors significantly improved discrimination (P < 0.001 for C-statistics and integrated discrimination improvement) and risk reclassification for heart failure (net reclassification improvement 12.12%, P < 0.001).
  
  
  CONCLUSIONS
  In a healthy general population sample of the FINRISK 1997 cohort MR-proADM significantly predicted all-cause death, MACE, and especially heart failure even beyond NT- proBNP. It also improved risk reclassification for heart failure.
authors: Hamburg University Heart Center , Hamburg , Germany.
authors: Anne
authors: A
authors: Funke-Kaiser
authors: Aki S
authors: AS
authors: Havulinna
authors: Tanja
authors: T
authors: Zeller
authors: Sebastian
authors: S
authors: Appelbaum
authors: Pekka
authors: P
authors: Jousilahti
authors: Erkki
authors: E
authors: Vartiainen
authors: Stefan
authors: S
authors: Blankenberg
authors: Karsten
authors: K
authors: Sydow
authors: Veikko
authors: V
authors: Salomaa
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005387:Finland; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D045265:Natriuretic Peptides / Q000097:blood*; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*
chemical_list: D045265:Natriuretic Peptides; D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin; D002097:C-Reactive Protein