title: Risk stratification and treatment effect of statins in secondary cardiovascular prevention in old age: Additive value of N-terminal pro-B-type natriuretic peptide.
abstract: To date, no validated risk scores exist for prediction of recurrence risk or potential treatment effect for older people with a history of a cardiovascular event. Therefore, we assessed predictive values for recurrent cardiovascular disease of models with age and sex, traditional cardiovascular risk markers, and 'SMART risk score', all with and without addition of N-terminal pro-B-type natriuretic peptide (NT-proBNP). Treatment effect of pravastatin was assessed across low and high risk groups identified by the best performing models.
  
  
  
  Post-hoc analysis in 2348 participants (age 70-82 years) with a history of cardiovascular disease within the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) study. Composite endpoint was a recurrent cardiovascular event/cardiovascular mortality.
  
  
  
  The models with age and sex, traditional risk markers and SMART risk score had comparable predictive values (area under the curve (AUC) 0.58, 0.61 and 0.59, respectively). Addition of NT-proBNP to these models improved AUCs with 0.07 (p for difference ((pdiff)) = 0.003), 0.05 (pdiff = 0.009) and 0.06 (pdiff < 0.001), respectively. For the model with age, sex and NT-proBNP, the hazard ratio for the composite endpoint in pravastatin users compared with placebo was 0.67 (95% confidence interval 0.49-0.90) for those in the highest third of predicted risk and 0.91 (0.57-1.46) in the lowest third, number needed to treat 12 and 115 (pdiff = 0.038) respectively.
  
  
  
  In secondary cardiovascular prevention in old age addition of NT-proBNP improves prediction of recurrent cardiovascular disease, cardiovascular mortality and treatment effect of pravastatin. A minimal model including age, sex and NT-proBNP predicts as accurately as complex risk models including NT-proBNP.
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands r.k.e.poortvliet@lumc.nl p.g.van_peet@lumc.nl.
authors.forename: Rosalinde Ke
authors.initials: RK
authors.lastname: Poortvliet
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands.
authors.forename: Petra G
authors.initials: PG
authors.lastname: van Peet
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands.
authors.forename: Anton Jm
authors.initials: AJ
authors.lastname: de Craen
authors.affiliation: Department of Medical Statistics, Leiden University Medical Center, The Netherlands.
authors.forename: Bart Ja
authors.initials: BJ
authors.lastname: Mertens
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands Netherlands Consortium for Healthy Ageing, Leiden, The Netherlands Institute for Evidence-Based Medicine in Old Age, Leiden, the Netherlands.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Mooijaart
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands Netherlands Consortium for Healthy Ageing, Leiden, The Netherlands.
authors.forename: Liselotte W
authors.initials: LW
authors.lastname: Wijsman
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands.
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Drewes
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.affiliation: British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, UK.
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.affiliation: Department of Cardiology, Leiden University Medical Center, The Netherlands.
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.affiliation: Academic Section of Geriatric Medicine, University of Glasgow-Faculty of Medicine, Glasgow Royal Infirmary, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Stott
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: de Ruijter
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands.
authors.forename: Jacobijn
authors.initials: J
authors.lastname: Gussekloo
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009426:Netherlands / Q000453:epidemiology; D010446:Peptide Fragments / Q000097:blood*; D017035:Pravastatin / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D017035:Pravastatin
keywords: Aged; cardiovascular disease; hydroxymethylglutaryl-CoA reductase inhibitors; pro-brain natriuretic peptide; risk factors; secondary prevention