title: Amino-Terminal Pro-B-Type Natriuretic Peptide Improves Discrimination for Incident Atherosclerotic Cardiovascular Disease Beyond Ambulatory Blood Pressure in Elderly Men.
abstract: Improvement of risk prediction for atherosclerotic cardiovascular disease (ASCVD) is needed. Both ambulatory blood pressure (ABP) and biomarkers amino-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein and cystatin C improve risk prediction but they have not been evaluated in relation to each other. We analyzed whether NT-proBNP, high-sensitivity C-reactive protein, or cystatin C improved risk prediction beyond traditional ASCVD risk factors combined with 24-hour systolic BP (SBP). Secondary aim was to evaluate whether ABP improved risk prediction when compared with models with the biomarkers. We followed up 907 70-year-old men, free of baseline disease, for incident ASCVD defined as fatal or nonfatal myocardial infarction or fatal or nonfatal stroke for a median of 10 years. Cox regression was used to estimate the association between variables in the models and incident ASCVD. Biomarkers were added to a model containing both traditional risk factors and ABP and the models were compared on C-statistics and net reclassification improvement. Twenty-four hour SBP improved discrimination for incident ASCVD when compared with office SBP in a traditional risk factor model (area under the receiver-operating characteristic curve, +2.4%). NT-proBNP further improved reclassification (+18.7%-19.9%; P<0.01) when added to ABP models, whereas high-sensitivity C-reactive protein and cystatin C did not. Twenty-four hour SBP significantly improved net reclassification when added to a traditional risk factor model that included NT-proBNP. The combination of 24-hour SBP and NT-proBNP improved discrimination and net reclassification for incident ASCVD when compared with office SBP in elderly men. NT-proBNP, but not high-sensitivity C-reactive protein or cystatin C, improved risk prediction and discrimination when added to a model that included ABP.
authors.affiliation: From the Department of Medicine-Solna (P.H.S., P.S.) and Institute of Environmental Medicine, Unit of Biostatistics (J.H.), Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (P.H.S., P.S.); Department of Medical Sciences, Cardiovascular Epidemiology (J.Ä.) and Department of Public Health and Caring Sciences/Geriatrics (B.Z.), Uppsala University, Uppsala, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.); and Medical Products Agency, Uppsala, Sweden (B.Z.). per.skoglund@karolinska.se.
authors.forename: Per H
authors.initials: PH
authors.lastname: Skoglund
authors.affiliation: From the Department of Medicine-Solna (P.H.S., P.S.) and Institute of Environmental Medicine, Unit of Biostatistics (J.H.), Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (P.H.S., P.S.); Department of Medical Sciences, Cardiovascular Epidemiology (J.Ä.) and Department of Public Health and Caring Sciences/Geriatrics (B.Z.), Uppsala University, Uppsala, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.); and Medical Products Agency, Uppsala, Sweden (B.Z.).
authors.forename: Jonas
authors.initials: J
authors.lastname: Höijer
authors.affiliation: From the Department of Medicine-Solna (P.H.S., P.S.) and Institute of Environmental Medicine, Unit of Biostatistics (J.H.), Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (P.H.S., P.S.); Department of Medical Sciences, Cardiovascular Epidemiology (J.Ä.) and Department of Public Health and Caring Sciences/Geriatrics (B.Z.), Uppsala University, Uppsala, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.); and Medical Products Agency, Uppsala, Sweden (B.Z.).
authors.forename: Johan
authors.initials: J
authors.lastname: Ärnlöv
authors.affiliation: From the Department of Medicine-Solna (P.H.S., P.S.) and Institute of Environmental Medicine, Unit of Biostatistics (J.H.), Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (P.H.S., P.S.); Department of Medical Sciences, Cardiovascular Epidemiology (J.Ä.) and Department of Public Health and Caring Sciences/Geriatrics (B.Z.), Uppsala University, Uppsala, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.); and Medical Products Agency, Uppsala, Sweden (B.Z.).
authors.forename: Björn
authors.initials: B
authors.lastname: Zethelius
authors.affiliation: From the Department of Medicine-Solna (P.H.S., P.S.) and Institute of Environmental Medicine, Unit of Biostatistics (J.H.), Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden (P.H.S., P.S.); Department of Medical Sciences, Cardiovascular Epidemiology (J.Ä.) and Department of Public Health and Caring Sciences/Geriatrics (B.Z.), Uppsala University, Uppsala, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden (J.Ä.); and Medical Products Agency, Uppsala, Sweden (B.Z.).
authors.forename: Per
authors.initials: P
authors.lastname: Svensson
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000097:blood / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis*; D055316:Cystatin C / Q000097:blood; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein
keywords: B-type natriuretic peptide; C-reactive protein; aged; blood pressure monitoring, ambulatory; blood–brain barrier; cardiovascular diseases; cystatin c; longitudinal studies