title: Serial measurement of N-terminal pro-B-type natriuretic peptide and cardiac troponin T for cardiovascular disease risk assessment in the Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: BACKGROUND
  N-terminal-pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (TnT) predict cardiovascular disease (CVD) risk in a variety of populations. Whether their predictive value varies by ethnicity is unknown. We sought to determine whether NT-proBNP and TnT improve prediction of incident coronary heart disease (CHD) and CVD, independent of CVD risk factors, in a multiethnic population; whether NT-proBNP improves prediction compared with the Framingham Risk Score or the Pooled Cohort Risk Equation; and whether a second NT-proBNP further improves prediction.
  
  
  METHODS
  Both NT-proBNP and TnT were measured in 5,592 MESA white, black, Hispanic, and Chinese participants (60% nonwhite; mean age 62.3 ± 10.3 years) in 2000 to 2002 and 2004 to 2005. We evaluated adjusted risk of incident CHD and CVD based on baseline and change in biomarker concentration.
  
  
  RESULTS
  Participants were followed up through 2011 and incurred 370 CVD events (232 CHD). Concentrations of NT-proBNP and TnT varied by ethnicity. Both NT-proBNP and TnT were associated with an increased risk of events (adjusted hazard ratio [HR] for CHD [95% CI] for fifth quintile vs other 4 quintiles of NT-proBNP, 2.03 [1.50-2.76]; HR for CHD for detectable vs undetectable TnT, 3.95 [2.29-6.81]). N-terminal-pro-B-type natriuretic peptide improved risk prediction and classification compared with the Framingham Risk Score and the Pooled Cohort Risk Equation. Change in NT-proBNP was independently associated with events (HR for CHD per unit increase in ΔlogNT-proBNP, 1.95 [1.16-3.26]). None of the observed associations varied by ethnicity.
  
  
  CONCLUSIONS
  Both NT-proBNP and TnT are predictors of incident CHD, independent of established risk factors and ethnicity, in a multiethnic population without known CVD. Change in NT-proBNP may add additional prognostic information.
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of California, San Diego, CA. Electronic address: lbdaniels@ucsd.edu.
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.affiliation: Department of Medicine, Division of Cardiology, Veterans Affairs San Diego Healthcare System, La Jolla, CA.
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.affiliation: Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: deFilippi
authors.affiliation: School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN.
authors.forename: Otto A
authors.initials: OA
authors.lastname: Sanchez
authors.affiliation: Division of Cardiovascular Medicine, Stanford University, Stanford, CA.
authors.forename: Hossein
authors.initials: H
authors.lastname: Bahrami
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD.
authors.forename: Joao A C
authors.initials: JA
authors.lastname: Lima
authors.affiliation: Departments of Pathology and Biochemistry, University of Vermont College of Medicine, Burlington, VT.
authors.forename: Russell P
authors.initials: RP
authors.lastname: Tracy
authors.affiliation: The New York Academy of Medicine, New York, NY.
authors.forename: David
authors.initials: D
authors.lastname: Siscovick
authors.affiliation: Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
authors.affiliation: Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
authors.affiliation: Departments of Medicine and Pathology, Cardiovascular Research Institute, University of Vermont, Burlington, VT.
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of California, San Diego, CA; Department of Medicine, Division of Cardiology, Veterans Affairs San Diego Healthcare System, La Jolla, CA.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Maisel
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, CA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000097:blood / Q000175:diagnosis / Q000208:ethnology; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D020107:Troponin T / Q000097:blood*; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain